extension of that and we needed to close their borders to block the sale. that is not different than what we hear today about islamic terrorism and other issues like that. but what is even more astonishing is how a lot of our immigration policy makes it easier for national security threats to exist, makes it easier for these problems to grow in a lot of cases increase the ability of the national security threats in these opponents of liberty across the world to more exploit their advantages by taking advantage of american immigration law. one modern example of this is in 2010 there were about a dozen some always arrested in mexico. there were rumors that they were aimed members of the al-shabaab militia which is an islamist terrorist militia based in somali. the mexican authorities in their

incompetence release them early without any kind of records. there was a big for of a better word freak out in the american media. these guys are deftly coming here and coming to the united states. they're going to wreak havoc and as a result border patrol and these people were eventually apprehended or they faded away and nothing happened but the point is because american immigration enforcement because our immigration laws are so focused on keeping people out for economic reasons or for any other types of reasons a small amount of what they are pulled to do focus on legitimate threats. instead they are more concerned with asking how will an additional worker affect the wages for american tomato pickers? they're more concerned with how one additional worker will affect the labor market conditions or computer programmers in silicon valley. they are more concerned with where a high-skilled immigrants will take a conference call with her is at his home or whether that home is listed as a place

of residence or as a place of work than they are about these legitimate threats that are out there. we are really concerned about this. if we think that we live in an age that is so dangerous internationally that immigration needs to be restricted and regulated okay if you believe that's true than you should argue for a total refocusing immigration away from keeping out willing workers and separating them and focus entirely on the small but real national security threats that exist. throughout history these threats have also been used to our disadvantage. think about the numerous hoops and hurdles american immigration enforcement but in the 1930s and early 1940s on scientist trying to flee europe and come to the united states to work and eventually were employed to work in a manhattan project to help win the war. there is enormous bureaucratic

fear and keeping these people out because of national security. a lot of these people had ties ties to common is our alleged ties to communist. because of the fear of national security -- one of my favorite examples is there was a chinese rocket scientist. he died in 2009. he was involved with rocket research in united states in the 50s. because of the national security law that said that communist could not be employed or emigrates united states he was investigated by the fbi and they said there was enough circumstantial evidence that he had attended a communist rally 20 years before the end he was kicked out of united states and deported to communist china where he was the founder of international rocket and missile program. the entire rocket program in china is based on the internetting expertise of this immigrant to the united states who wanted to stay here and live and work but was forced back to china as a result of that. i am a libertarian and i don't

leave china is an accidental threat to the united states anything like that but if you are worried about this about national security issues coming from other countries the last thing you want to do is to send talented foreigners who have come here to learn these issues back to their home countries. that's pretty much the last thing you want to do. now i think switching gears to culture and how really americans have taken a look at immigrants and treated them to the much the same throughout history. we have always been skeptical of them and compare them negatively to previous immigrants. it's a quote i thomas sowell and a recent article written on june 4 titled abstract immigrants where he writes the immigrants of today are very different in many ways from those who arrived here 100 years ago. i think he massively exaggerates the differences between immigrants today and back then. we heard a lot about these

differences but what is also different or americans today. it's true multiculturalism has impacted american society to an extent and i think that's a bad ideology that we are also in a lot of ways more welcoming. americans today may say nasty things about immigrants today but let's not forget the largest mass lynching in american history's was in the 1890s in new orleans of italian immigrants by a mob of white americans that thought they had committed a crime and had gotten away with it. in in the 30s ahead matzo protestant americans going out and burning down churches catholic churches occupy by the irish burning down and destroying confidence raping the nuns inside and horrible things like this. the rhetoric today about immigration of americans who are opposed is nasty and it is gross but we don't have this level of cultural aversion violence to the extent that people are going

out and doing this. americans are behaving much better in the face of immigration than they did back in the day. and i think that comes across as well. these worries about immigrants being different or totally exaggerated. the catholic example is a great one. immigrants today are majority catholic just like they weren't 100 years ago. they come from different countries in the world in different parts of the world. what is most remarkable about assimilation especially for mexican-americans and the descendents of mexican-americans is that so many of them came in illegally. they came to this country illegally and they lived for years oftentimes in the black market. the extent to which they and their children have assimilated truly in a lot of ways outpaces the tying immigrants who came legally 100 years ago who were able to live entirely within the legal market. what is truly remarkable and i think if immigration was allowed to be dashed to the extent that

all had come legally they would see a better pace of assimilation. looking at it that way in realizing immigrants to come today are more un-american when they calm and they become americans faster despite having to live in the black market i think is a testament not just to the entrepreneurial and energetic spirit of immigrants today and how they want to become american but also a testament to how much american culture has influenced so many people throughout the world and how we we are still a beacon for millions of people who want to come here and want to become americans. i think this book really goes into fantastic detail about that process about the cultural process by which people become americans. it differentiated from a lot of other books out there that sociologists write about assimilation. it really describe the process. it creates a model for how it happens and it was the first time i'd read that third generation.

your parents are born here and you look longingly back on that ethnic or religious identifier where your parents came from or your grandparegrandpare nts came from and that is a feature of success. that is a market success of becoming an american because because as merrick is we don't have an ethnic or racial identifier. the largest ethnic group in the united states is german. that's going to change in the near future. that is the largest group. we don't have any blood borders culture conception of being american. it's a value conception, it's a civic notion of being american and that is something that is virtually unique throughout the world and unique throughout history and what this book does is describe that in some of the best detail i have ever read anywhere in the literature and both sociology and economic academics and even in popular books made for a popular

audience. for that notion i think it made me -- a steady immigration policy and sometimes i become skeptical of the way my government does things and i've become skeptical of the united states and its immigration policy but this really filled me with more enthusiasm and more hope for the future of this country and the ability to assimilate immigrants and to be a beacon than virtually any book i've read in my years of working on this topic so i highly recommend it to all of you. i couldn't recommend it more. it's a beautiful book and thank you very much for coming today. [applause] >> thank you alex. we have time for questions and if you have a question please raise your hand and wait for the microphone. identify yourself and your affiliation. so we will take the first question up here in the front, please. wait for the microphone please. >> hi.

my name is stephen. i have no affiliation. i was kind of interested in this notion of low unskilled workers versus high-skilled workers as whether we want immigrants are high-skilled or low-skilled. it always seemed to me that human beings are a resource and therefore if lots of low-skilled employees is a resource because -- it doesn't mean that we don't need the high-skilled but this idea that there is only a set number of jobs for low-skilled -- look at all the people that came to new york city that were low-skilled at the turn-of-the-century area jobs were created. in other words i think there is a misconception that you look at an economy and you say well we only have this amount of need

right now for low-skilled but i think the answer is if you bring more resources that is more low-skilled workers, businesses will take advantage of that low-skilled. we will produce goods that will take advantage of these low-skilled workers. even if that production doesn't constitute this it will come to exist because the incentive. what i am saying to you my question is isn't that another big misconception that you guys seemed to overlook and you always hear so many people say we only want high-skilled labor with immigration. >> thank you very much. i couldn't agree with you more. i look at it in a different way. one way to look at it is just look at it domestic league. much of this discussion would be better understood by people if

they thought these issues in the domestic context. since the second world war the u.s. has added about 100 million people to the workforce if you count baby boomers in general and women in particular. if the argument is made against immigrants were true on the economic level that those 100 million people would have destroyed the u.s. economy it would have generated so much unemployment and that would be the number one issue in the united states on a permanent basis and that is not the case. in the 60 years there has never been long-term unemployment of any kind. there has been unemployment of course in times of recession but that have different causes. look at arizona for instance which is such a sensitive place for this debate. just before the bursting of the bubble i looked at unemployment rates in arizona. among the lowest in the country,

4% and is sometimes less than 4% and get 10% of the workforce was and ice and continues to be immigrant. so clearly it's not generating unemployment. it is generating growth because arizona is a wealthy state and it is helping make as i said the pie larger. that includes both low-skilled and high-skilled immigrants. ..

yet at the same time we had an constant inflow of immigrant. it wouldn't have been possible if immigrants were hurting that productive process. >> if i could -- yeah, if i could add one small thing to do that. i have been doing a series of debates for the last couple of times this week. i have another one on sunday. the issue is always brought up, and the analogy i like to use is if we have 100 high-skilled people in a room. 100 college grads and bring in 50 more. the economy gets bigger production increases. the rejoinder critics say you lower the average education level in the room by doing that. that really shows, i think, the danger of knowing a little bit of math and knowing not very much economics. an average of the terrible way to describe that. it's a example of the danny devito fallacy. the average height in the room will i did crease.

-- decrease. nobody is actually any shorter. that's something that is pervasive. talking about public policy and the impact of immigration on the economy by using broad averages like this, really is probably one of the worst ways to do it and betray a total of lack of understanding how economics works. >> question right there. >> my name is steven. a wonderful, wholly convincing presentation. one aspect i'm wondering about the effect on the nation that immigrants leave from. are those nations any worse off? for example, it was said that when the 1848 revolution failed failed in germany. a lot of german liberals here and germany became more autocratic. today as much as we complaib in the building about economic regulation.

a lot of immigrants see the united as a more fertile place for -- applying entrepreneurial skills. are countries that immigrants leave from worse off, say, in term of entrepreneurial skills? >> that's a great question. well, what -- if we look at -- forget about nation-states and borders for a moment. what are we talking about? we are talking about how people are able to create the most value. in other words, they choose their location according where they can create the most value and exchange the friewft our labor according to what we need and what we can offer. if you look at that way you'll realize people moving in or out is not going have a long-term effect of a negative kind in any way. europe was exporting people, again, until the 1980. the country were becoming more

and more prosperous. they are a mess today for different reason. we had the same in latin america. people my grated to vens with a lay from countries such as peru on a consistent basis for half a century. it's a wealthier country than venezuela. look at it this way as well. chinese immigration in the united states has played a key role in the growing economic prosperity of china, they have not only of course been able to export stuff and import stuff to them. they invested in china response i think that borders and barriers are really art initial term of the impact on the economy. we all benefit from the constant circulation as people. the same is happening in europe. some of the eastern -- or central european countries have been -- in the last few years. it became legal to do so.

and yet they have been becoming more and more prosperous. poland is more prosperous. it export the an incredible amount of people to spain. >> i have some small things to add. he's 100% right. about the german 1848ers. they left behind complained about the liberals leaving. americans who experienced and met them complained about the autocratic germans who are bringing their socialist notion of collectism. 1848 formed a core of what became the republican party in the antislavery wing. that's a little about dote about the feeling of immigrants destroying the core of america no matter where they're from. the issue you talk about, you know, does immigration an e leave the sending country worse off? that usually takes the frame of the brain drain. that's what people call it. they say the best and the

brightest and the most energetic leave and what is left behind everybody else suffers. that's assumes a person in a country is a property of everybody else in that country. which is a terrible notion that no person who has any concept of individual freedom or liberal in the classic call sense interpretation could actually deal. what we actually see is when the opportunities to e mate, -- e grate. they go to school more. they acquire more skills in order to do better in the source -- and in a country where they want to go to. at love them end up staying. we see this in south africa, in nursing scoop. a lot of lot of people go there to try to emigrate to the utah. a lot stay behind. we see it in the philippines. the filipino nursing program. they have some of the highest percentage of nurses of any country in the world because there's a possibility to leave

when they have it. as a result the rest of the pill fee knows -- filipinos gain from that. you're right it's a weird argument used by most i are restrictionist to say immigration is bad for people in poor countries when it's not true. >> i guess i would add, i mean, -- so it does the opposite. >> yes. >> george washington university. i'm one of the academics you speak of. and i, you know, i love the presentation. thank you. i'm a little bit uncomfortable with your romantic vision of assimilation and acceptance. because we know that some groups are more asimilarble than others. perhaps you tell us a little bit about how you define assimilation; right. because, you know, how many times have the third or fourth generation immigrant been asked where are you from?

all right. what language do you speak. maybe you can talk about how you think about assimilation. assimilation is not only based on the desire for individual but also on the desire for the larger society to allow that person to assimilate. >> well, about the first part is are they asimilar plaiting -- assimilating, you know, immigrants assimilating today the way they did in the past? and the an is definitely yes. the research is very extensive. i looked in to this in a lot of detail. there's many ways to measure it. whether it's, you know, the use of english. or mingling with the native born population. marriage, whether it's entrepreneurship. that's another way to measure this. the idea that the lot of entrepreneurship that is home grown but these hispanics are bringing in notions, you know, to entrepreneurship. that's not true. the rate of self-employment among hispanics almost equal the

rate for native born americans. almost 12%. and the number of companies that are founding every year is just amazing and astounding. what does happen is this, which is something alex touched upon in his comment in the book, which is fascinating. the first generation of course, is first generation. they are trying to find their way around and try to fit in. at the same time they have attachments back home. incidentally you should look, people ask me mexicans are tied to their home country. it didn't used to be the case. read some of the letters italian were sending back home in the 120th century. full of italian passion. expressing profound follow stall georgia and sending money back home as well. that's totally natural. the second generation moveses in the opposite destruction. they are 0 conscious of being seen by u.s. society as not

really fitting in, as being somehow different they escape from their root. they reject the roots to an extent. i wouldn't -- that's not fair, you know, for everybody, but certainly there's big percentage of that. yet, by the third generation they feel so secure they go back to those roots but the a different way. a purely sentimental way they begin to -- simply because they know they are so secure and accepted by u.s. society that there's no risk in that. that's really how cinco de mayo was born. it was never a big deal in mexico. it's a big deal here. because it's a big deal here mexicans back home start thinking it's uncomfortable because mexico immigrants are more patriotic than we are. we have to assume it's a national holiday. now in mexico they are celebrating it. that was the result not of first generation immigrants. certainly not of second generation immigrants.

this was third generation immigrant they thought of it about time to celebrate that. who celebrates cinco de mayo it's not just mexicos. it's americans just like irish and italian holiday. as alex said, the country is not based on the nation-state here is not based on flood. it's based open credo. it's not a nation-state it's a nation of nations. a state based on credo. i think the reality speaks to that. >> i think the cinco de mayo example is great. i can't think a more american holiday than the defeat of the french army. that's what it is. and, you know, to go in to some, you know, more. this is what he writes a chapter here about the phenomena. it's about the immigrants moving toward the main stream society and in the main stream society moves toward them. whey learned in the book everything i like to do on sundays comes from the germans.

i mean, i like to go bowling. i like to go to the shooting range nap is something that germans did on sunday that was really un-american in the 1870. people were afraid of that because, you know, the old puritanical version of sunday was you sit at home and, you know, go to church. you sit at home, you read the bible, and basically don't do anything that is fun. and the germans were like, no, we're not going do that. what to do we do on sunday? go out and have picnic and have a good time. that's app example of american society and changing partly to the immigrant and their culture. it's pretty clear that the immigrants do most of the changing. >> we'll take question in the back. >> hi. i'm emily colins from the atlas networking. my question for you, it seems

like there a couple of institutional thing in the government that may need to change in relation to immigrant such as the minimum wage or welfare. at love immigrants work under the minimum wage and illegal immigrants may take welfare or became legal might take more welfare. people argue it would be associate drain on society. i was wondering for you would speak on whether or not that has been discussed in the house or in the senate or your opinion on that. >> sure. the congressional budget office just came up with a report calculating what the impact in fiscal terms would be legalizing 12 million people for the next decade and beyond. they did two different calculations. you know, a -- i don't want to get too technical something called dynamic scoring.

you calculate the effect on the economy will be. and you calculate what the fiscal impact of that will be. the other way of doing that is calculate the fiscal impact assume there no huge change in the economy. chevre way you look at it, the impact is beneficial. what they to is simply calculate what intake is going to be on the deficit and it's going to be a very positive impact in term of reducing the deficit. but as i said, there are many studies that very respectable studies that indicate that contribution is very positive. just thinking of one of the point. i mention the national research council. there's another one that was very significant at the time. jeffrey did a study of what happened between the 1970 and the 1990s. that's two-decade period. he came up with a figure i think very significant. the net contribution was $25 billion. but again, when you look at it,

you always think that the effect of immigration on the economy goes beyond what they themselves produce and consume and they themselves pay and what they themselves take out of the system. the impact the whole of u.s. society. they make all of society more productive. the entire economy more productive. ultimately it's almost impossible calculate what the impact will be. we know it will be positive because if the economy becomes more product iand producing more goods and services. by definition you're going bring more revenue to the government. ultimately, if that were not the case, though, that's a great argument to get rid of the welfare state. i mean, immigrant were not to blame are not to blame for the fact that government spending has gone up by a factor of 50 in the last seize pry until the second world war they weren't entitled relief programs. we had welfare reform in the 1990s that impacted immigrants as well.

now they are able to use that system only in a very limited way. >> there's very few things more dangerous about the welfare state than it changes the perception of being asset and good for society to liabilities. to viewing people entirely of cost and to look at this, you know, one government agency to look at that and say people who take from there are a net cost are terrible. we did research here at the cato institute. we hired a couple of professors, recently at george washington to do a study about how much welfare for poor immigrants use compared to poor native-born americans. that's the relevant comparison. you want apples to apple. poor people to poor people. what we found is poor americans use medicaid at the same rate as poor immigrant and took the same amount of immigrants the program would be 42% smaller. it would be a huge savings. for some people when they look at the immigrant of taking a

dollar of welfare. the damage is magnified beyond all comprehension compared to an american citizens taking the same amount. now, you know, i favor getting rid of the welfare state for everybody. but if we can't do that,let build wall around it, at least, and try to improve the perception and try remove the perception that immigrants are takers. they make far, far more an contribute far more to society than the paltry amount they take in welfare. >> okay. a question in the front row. >> thank you. my name is -- [inaudible] i'm an economist. thank you very much for the presentation. especially for the -- i couldn't agree more. in spite of the overwheking economic and cultural of the benefit -- everywhere across the world. how is it it the anti-immigration arguments find a for the fertile soil.

you look at the experience of other countries, i'm sure you have done in the book, but can we draw any lessons from the way the country say europe or canada the way they have dealt with the myth in order have an immigration policy which makes culture sense. second question there's one myth where i couldn't agree with you. you said that the myth of the immigrants have a lot of children. i think that the myth that cannot be refuted because they a lot of more children. it's one of the economic benefits that immigrants bring younger population and generation or so. they have more children, and bring in influx of younger people to the nation and to the economy. that's a plus. >> great points you make. first, answer ting has to do with fear. any community that is faced

faced faced with an influx of newcomers will be afraid. it will rationize that fear with arguments of the kind we tend hear because you proved to them those arguments are not true. you prove they are myth. you throw at them the statistics and historical experience. and yet that fear remains. i think it has to do with fear. that's how stereo type were born. you know, at the time of the irish immigration, the idea was irishmen were drunk. that was a stereo type. all italians were mobster. there may have been one or two but not all italians were mobsters. not all catholicses were repressive. we embrace them because they are about religion and values. catholic were hated a few centuries ago. they saw him as european repressers so today we have the stereotype that his pans --

hispanics are different and worse. we begin to embrace indians because of contribution to silicon valley. they were also the object of stereo type. about children, it's definitely coming down. even in europe. there's no question. it's slightly higher that night native rate in europe it's about two children. here it's 60% higher than the native rate. but the tendency is coming down. that's also the case in latin america. and incidentally one more point about the previous question connected to this. the average age for immigrants is 27. the average age for americans is 42. so again, that's a -- welfare state is what we really care about. clearly that's a plus. that's more years of con fry biewtion to the system. and in term of taking money out of the system, of the tran for system, only 1.2% of immigrant

over 65 against 12% for the u.s. population. so, again, if those arguments were real, then, you know, those fears should be dispelled by the evidence. i think there's fear at the heart of this. it's very difficult to dispel. >> about why the rest of civilization and society doesn't take up the well known argument and fact and economics. i mean, i wish that immigration was the only instance of that. , i mean, there are so many economic notions that have been known for quite a long time that are not taken up in the main stream society. intellectually, i think we won the debate about free trade. when you ask the common person, you know, do you think we should be able to import goods and social securities from china without any kind of government. it's no, it takes american job. of course there should be barrier. i think the notion goes beyond this to the conception that there is a fixed pie. i think people have this ingrained notion there's a fixed pie of wealth. a fixed pie of jobs, a fixed pie

of x, y, z. having more people come to the country will decrease the amount available us. i think it's a wrong headed notion. it's something we have been fighting against every sphere of public policy. for a long period of time when it has to go economics. and we have a lot of work do with immigration especially but numerous other issues. >> we have time for one more question if there is one. we'll take right there. >> hi. my name is mike. i'm a retired foreign service office with the agency for national development. i was previously the officer in charge of central america. we looked at the lot of issues in central america. and basically i looked in your book and i was going through the idea that most of the poor people do --

maybe within central america. i read in your prolowing mostly poor central americans and mexicans as, you know, in effect the drug war going on. this is a key issue. we have disease in central america right now for coffee plants called coffee rust. it's going impact about 3 million workers in central america that work in that sector. there is talking about 40 to 50% loss of the sector and loss of their employment. if they can move north, i think they may. i'm not sure it's on anybody's radar screen. it you are right you won't move north. they'll basically change their area of location within central america. that will also have impact. i would like to get your perspective on what could happen. it happened in the past. that's why we have different type of migration from central america before inspect is

pending and coming up. >> well, i mean, it's not inconceivable that a small percentage of them will try to move north and eventually come to the united -- united states but they indicate they will mostly my grate within the area. if that what happened in central america. even in mexico. it's something people don't talk about all that much. i know, the experience of my home country of peru very well. it's a country in the last fifty years has seen a huge amount of migration internally. so much so everything has been impacted. the story incidentally is no different than the united states. domestic immigration is four times larger than international immigration for the united states. so it's just a pattern that seems to be repeating itself everywhere. so i don't know exangtly what

will happen with the people. if we can go by historical precedent, it's very likely that that will not have a huge impact in term of international migration. of course, it would probably have an specific domestically in term of the economy. that will take us to the whole issue of the central american economy, institution, drug war, and all of that. it's a different issue. >> yeah. a few hispanics in the research, they looked from 2002, 2010, the increase in origin of different countries of my grants. central america was 16.5%. it was off the charts compared to any other origin. the next was 9% for south america. mexican country of origin was like 2% increase. something is happening. ethan, you map it out here incredibly difficult to come.

but people still coming. and from central america, they're really coming. >> it's because central america is not doing that well and mexico has been doing better the last few years. which is why i predicted that a few years from now, the debate in the u.s. will be where are we going to get immigrants from? the mexicans don't want to come anymore. mexico is growing in 4% a year. i think it that will go to 6% and enough to ash absorb the new work force. they will be comingless and less and probably replaced by central americas for awhile until they take out the reform they need and get rid of the drug war which is devastating the whole area, by the way. in which case we need find them. i don't know where. it's going to be an issue. it will be, believe me, it will be an issue. there being recorded. twenty years from now mexicans won't want to don't united

states anymore. >> and, you know, it's interesting, since 2008 of lawful immigrants coming to the united states, asians have outnumbered the hispanics. now we use hispanic broadly. i'm an american, so i use it central and south americans. asians have outnumbered them in term of the lawful migration system. and the gulf is getting wider every and every year. asia is the new source going forward of immigrants to the united states. it's going the new historical dynamic. so i predict my kid, when they are adults. they will look back and say, alex, why were so many people upset about his cantic or mexican immigrant. it's absurd. these indians or, you know, these southeast asians. they are different. they are taking our jobs this time. that's when i'm going to hear, i think, in the future not only from my kids if i have done a poor job educating them but also people in society. >> it's fascinating and

encouraging discussion. i hope our friends on capitol hill pay attention to the points made today and read out of the book on sale here at the discount for all of you interested. thank you all for coming. please, join me in thanking our great speakers today. [applause] >> a luncheon following upstairs.

sanjiv.me to years befo at the time the vietnam war was coming to an end. this was before watergate. a lot of you wouldn't remember that because you were born. and there is a shortage of physicians in this country. we had to go outside, and we had to take the exam to come your. furthermore even if you passed

the exam you couldn't leave the country with more than $8, foreign exchange regulations. you know the story. you know the time. so we had an uncle in the navy. he gave me a gift of $100, $908, which if you're from india is a very auspicious number, 108, all of that. so i thought we have to do something really auspicious, and i went to paris and i spent my 108 at the moulin rouge. [laughter] when i arrived here in new york at jfk, i had nothing. in those days no cell phones. unity made calls and get to put money. somebody told me you can make a

collect call. so i made a collect call to a hospital in new jersey. they were so desperate that they sent a helicopter. there were such a shortage of doctors at that time. so my first experience of the united states is writing over manhattan and helicopter looking at the manhattan skyline come edge is totally being -- i want to go to disneyland. [laughter] but shortly thereafter we arrived, i was joined by the nurse who was in charge of the emergency room which was going to be my first rotation that i could take some rest, jet lag and so. so i went to the dorm, but 20 minutes later she called me and said, dr. chopra, we have -- i had no idea what that meant. but, of course, i didn't want to

let on so i said deepak, i'll be back. [laughter] accounted down the stairs but she showed me to a room and there was a dead person, lots of machines, no people. in india you see only people and no machines. so i looked at the patient. i looked at her. i made my first diagnosis. i said, he's dead. [laughter] she said, i told you. i said, but if he's dead why do you need a doctor? and she looked at me and she said, pronounce him. this is kind of a bizarre statement for me. your body, your soul can't leave your body until a medical -- otherwise known as indeed. so i release you, you are pronounced. [laughter] then i realized like everybody

else in our profession -- even in the face of the obvious, listen to the hard. we have learned english in india which is a little similar to british english where the word for flashlight is a torch. sunset to the nurse, may i have a torch, please? [laughter] and she now was looking at me very strangely. another nurse outside, chillicothe of the nurse, he wants a torch. [laughter] the other nurse qaeda sized me up and down and said maybe he wants to be a clinician. [laughter] talk about culture shock. but six hours later i was totally at home, you know? speared sanjiv, what were your first experience? >> weekend, i wife is also a physician. we were classmates at the same

medical school that deepak also went to two years earlier. a very competitive medical school, 10,000 people would sit for an entrance exam. out of got a certain score in pre-med, then they would whittle it down to 19, have an interview and than 35 are selected. in the book i write, my wife was first. she pediatrician and brilliant. out of 10,000 people are that i was also first. i was first on the waiting list. [laughter] to think about it, deepak had already been in the states for two years and we had heard stories and occasionally we would call him and talk on the long distance call. we decided to come to boston first before also going to new jersey, the same hospital where deepak had gotten his internship. so we stayed with deepak and his wife for starbase. so we've sort of less culture

shock, but for me one of the most interesting things that happen on day one of the internship, i had already decided i wanted to be gastroenterologist and a specialist in liver disease. the person giving the lecture anytime was a professor, was a gastroenterologist from new jersey. so he's about to give the talk, and there's a medical student from rutgers and he sitting in the front row and he's got his feet propped up in the air. and that would've been sacrilegious in india, and that was culture shock. a student sitting, and he sues are facing this world-famous professor. we would say yes or no, sir. good morning, sir. and it is a brilliant talk. i'm mesmerized. i take notes. i ask a question. in the medical student raises his hand, and he says i have a question. so doctor palmer said, sure.

he asked a question and doctor palmer gave what i thought was a brilliant answer and the student had this quizzical look on his face and he said, and i don't buy that. and i said, wow, what an amazing country. you can disagree. [laughter] with the professor. we would never even conceive of what think about doing something like that. so that to me was the first episode of culture shock. the other was we were told as interns that when you leave the hospital, you're not on call. call the hospital operator, call the operator and tell them, tell him or her that you were leaving the hospital and that you are signed out to whoever's on call. so the second day of the internship, one of the other doctors happened to be also from india, sanjiv, can i have done? i said, sure. i give them a dime. i see him go to the pain phone and he's calling the new jersey

bell operator. this is the doctor, i'm leaving the hospital. [laughter] and then he hung up. >> brilliant. deepak come how did you manage to basically educate a population, help change conservative western medicine to an equally important but different way to address some of the same issues, the most important no single-handedly create the feel of mind-body medicine? you were one of the greatest contributors to appear to come to the states in the 1970s. you and sanjiv going to the directions. sanjiv basically goes to harvard and you just did not stop with your persistence. you basically change the belief of what medicine was viewed in the states. how? >> several factors, in hindsight, okay? so i specialized and you went to

gastric indeed all day -- gastroenterology. then for a short while when i was at the va hospital, i was rotating at tufts under a doctor was the president of the endocrine society at that time. and he was a near endocrinology. he was the president of the society of america. he was just like, as the second we brilliant mentors. he was absolutely brilliant in those days, he was identifying hormones that we did know too much about at that time. hormones and the hypothalamus like stimulating hormone, like growth factors, et cetera. i had a colleague at that time, her name was candace. she later went on to become the chief of brain chemistry at nih.

she's now at georgetown university. check invite something called peptide -- if you know anything about it. but her boss won the nobel prize for identifying number of chemicals. -- muro chemicals. one day she said to me, you know these things that we're looking at, because there was a new technique, had won the nobel prize for discovering this technique. so all we did as fellows and residents was keep measuring these chemicals. and one day she said to me, you know these are the molecules of emotion. so i don't know -- [inaudible] the molecules of emotion by candace. i wrote the forward to. it was a huge book, and nobody had used that term, molecules of emotion. and so that was a little bit of

insight that whatever happens in the mind is registered in the brain. you can't have a mental event without a brain representation. how could you? after all, the brain is what mediates the event. the brain representation is in the form of electrochemical event. and then there's nothing that happens in the brain that is not registered in the body. in fact, what we found was that these chemicals, neural peptides, the receptors to them in the cells of the body, suddenly i have a gut feeling, a sense because that was responding to molecules of emotion. we will tell you that get makes the same chemicals the brain does within nerve chemistry. so this was a scientific background that the body, the network, this information, and information is mental.

it's from consciousness but that's a whole different story. but then as a physician, any physician will tell you you can have two patients who get the same treatment, who see the same doctor, have the same illness, and there are different outcomes. our prognosis, what we call prognosis, people on this site, people on this site, and although you can actually make a diagnosis, you can never accurately make a prognosis. it's like saying the temperature today in new york is 62 because the average temperature in new york is 62. it doesn't make sense. or your singer income is $100,000 because you come from manhattan, and the median income. it doesn't tell me anything about you. i was thinking to myself, why do patients respond unpredictably? even though we can statistically

get some idea, but for the individual you can't. just like for the individual particle, you cannot predict when it will pop in and out of the quantum vacuum. in fact, no individual event in the universe has a cause. until much later. so this is all scientifically going on. i started to write the experiences of my patients. nobody would accept that in a medical journal. i started to write them in a popular book. nobody would accept that. so this is, you know, one of those very strange things. i read an ad in "the new york times" by a vanity publisher called vanity press, or vantage press. i paid 5000, got a hundred books published myself with the experiences of my patients. it was called creating health.

somebody convinced the harvard school to put it in picked annexing i get a call from an agent or choose and why don't you have a partnership? i said because i tried. she said let me get you one. it was the same publisher of today's book, okay? in boston the next thing i get a call from a continued. i get a call from jackie on nasa's, of all the people. and she said, we want to get you published. what i've found was i could make a case for the public that it could make a case for my own profession. and that started in a sense the movement. >> this is an incredible bestseller out now called how children succeed. why do you think both of you have had the same success taking completely different roads? >> that's a great question. i have to reflect on. i think it's the core values

that were instilled in us by our parents and grandparents. and we were told, you know, to be airing -- daring, cannot worry about fed up. that in every adversity is a seat of greater success. one of my favorite quotes is from kierkegaard, great danish philosopher, and he once said, today it is to lose once footing momentarily. not to dare is to lose one's self. it's a beautiful quote. today dare is to lose once put momentarily. i think deepak was being modest when he started to talk about how he launched into his. i thought it was very gutsy and courageous when he embraced the mind-body connection. he had a thriving practice in boston. there were medical students from tufts university rotating. and one day he reads a book,

anthony campbell? joseph campbell. no, it was anthony. joseph campbell is the other campbell. mythology. [laughter] follow your blessed -- doors will open, that's a joseph campbell. but he writes another book by anthony campbell, seven states of consciousness. and the back cover there was, if you're more interested about meditation, call this number. so he went and learned meditation with his wife. he came to her home in newton, massachusetts, told my wife in the eye been editing for a month. it's the most powerful, life-changing event that's occurred to me. and i said to him, good for you. [laughter] i wasn't interested. if i had this concept of roads and satin robes and chanting. and my wife, a pediatrician and absolutely brilliant, went and learned.

then i noticed some amazing changes in her but i was a holdout for about a month. and then i said to the teacher of transcendental meditation, i said i three concerns about learning meditation. the first one is i'm in a position as the associate chief of medicine at the medical center, brilliant medical students, even junior college, and i don't want to become mellow. number two -- [laughter] i am playing in a tennis tournament and i'm in the finals, and a very competitive and i don't want to be just a plotting every passing shot that my opponent hits last night and number three, i enjoy that and i don't want to give it up. and he said listen, in terms of the scotch, most people start to drink less but in terms of attendance, i'll be back. and he comes back with the pamphlets that's called the teen program in ethics -- in athletics, excellence in action.

so i said that's good but will i win? and he said, i can't guarantee that but if you lose you won't feel that bad. [laughter] and then i said, okay, what about disciplining brilliant people at harvard medical school? he said, you'll be more assertive but from a silent level. and so i've learned meditation. it was the most powerful thing of them. now i tell my colleagues and medical students and house staff, i was interviewed in "the boston globe," give us some piece of advice at the end of the year. i talked about meditation. and the best thing i think is, it's an ancient saying, it says you should meditate once a day. if you don't have time to do that, you should meditate twice a day. [laughter] >> as an aside i should say though, you know, it's not really clear what happens. there so many circumstances that

story is true. the story i said is true, but also at a certain point what happened is i was in the practice with other physicians, a cardiologist, gastroenterologist, et cetera, and i started to notice that they were embarrassed about being my colleague. and i also realized that i was, at that time, an assistant professor at bu medical school. school. be and i got the feeling that they would fire me anyway so i should leave before they fire me. and i don't want to embarrass them. so at the time i met another friend of mine who has long since passed, and he invited me to california, and i left. so you know, these are things in hindsight something was going on. i was very restless. >> just a comment about that. back then they used to be called alternative medicine. it's as though you either took

off western medicine or this was an alternative thing you could do to help yourself as a patient. and even at harvard medical school we have complementary medicine, integrative medicine at deepak comes and gives a talk every year at a course of a drug with colleague of mine, martin, who's at the diabetes center. about 12 years ago the chairman of medicine at the medical center where i had my clinical appointment said, sanjiv, we should invite your brother to be the keynote. see if he could talk about spirituality and healing in medicine. and i said to them, i said, boss, i wouldn't feel comfortable with it. that's like a nepotism. but you can invite him. he invited him and the deepak has been coming for the last 12 years and doing a session that

too, two and half hours about spirituality and healing. more recently superb rant beyond bring. and i sit in the front row on the side i'm very proud of my brother, and martin abramson, my colleague was like a younger brother to me, introduces deep deepak. >> taking it for the winter you think outside harvard, across the united states and also across the world, when do you think mind-body medicine will be on equal standing and fully accepted universally? more and more people, most of the people here are real strongly attracted to mind-body medicine. when do you think it will get the respect that it deserves? because it's affecting so many people so positively but when does it enter the curriculum question mention harvard but how about all types of other universities? >> we are going of a different take on this. let deepak go first. >> so for things to be accepted there has to be evidence and

there has to be documentation, write? so right now on the research side the main interest is in cellular biology and a measuring genomic activity and what -- the super brain. it turns out that only 5% of your genes are fully penetrant. the rest respond to your lifestyle, okay? which means everything from sleep to diet and exercise distress to personal relationships, social interactions, environment, everything that is other than the genes, okay? that's brand-new information. nor plasticity, brand-new information. as you get a scientific findings in o.b. clinical studies but right now we're doing studies with a nobel laureate, elizabeth blackburn from looking at the genome. it was a weakness -- there was a

recent study. the thing that people are realizing is that your body is not a noun. it's a verb. see, when we look at a molecule it's like taking my photo and saying, that's deepak. the body is an activity. when you look at something you freeze the activity and you call it a molecule, but you can't stop the activity. so this kind of insight is going to influence the way research is done, it's going to influence the way we do clinical studies and the clinical studies are, we call them double-blind studies. but there's a problem because there's always a doctor-patient interaction no matter how double-blind you are. and you can't really measure that so easily. so the are compounding factors, but the fact is at our center we have 35 hours of cme credit for anyone who takes a mind-body training at our center, given by the american medical association. we have students from u.s. cd

going to our center. almost every hospital in the u.s. anyway has a department of integrative medicine. so we have come a long way. >> it's actually happening at harvard medical school. i'm very humbled and proud to serve as a faculty dean for continuing medical education at harvard medical school. i direct 12 postgraduate courses, but under the jurisdiction of the aegis of continued education, we have 275 postgraduate courses, distance learning, 70,000 people, 100 models. we reach out to about 90,000 clinicians and physicians and allied health professionals throughout the world. a couple of years ago we had a course called medication and psychotherapy. the keynote speaker there was his holiness, the dalai lama. he did a three hour session on

wisdom one day, and the next a three-hour session on compassion. and it was actually breathtakingly beautiful. as part of the faculty in addition to harvard medical school faculty, we have richard davidson. and he's considered one of the top 50 neuroscientists in the world. and talk about humility, sometimes someone would ask the dalai lama a question and he would succumb i don't know the answer to that, please ask my guru, richard davidson. richard davidson has some studies, but this is true, deepak has mentioned it, and he is done some studies at harvard. not going to people in meditation have a subjective experience of feeling happy, creative, better relationships, but you see anatomical changes in the brain. you can see them on cat scan. you to functional mri and you can see changes in different parts of the brain. so that's happening and that's

the concept of nerve plasticity. we have a physician, a brilliant professor of neurology at harvard medical school, and he talks about nerve plasticity. he talks about neurons. he talks about an earl biology of leadership. when you have time, if you haven't heard about neurons, read about it. but one of the most fascinating syndromes to me in medicine is phantom limb syndrome to someone has an amputation of albany on the right side and they experience pain. in the missing limb, and here's a study that a lot of us quoted, he has done some of the research. so somebody is expensing phantom limb syndrome and ex-im a stranger is sitting and massaging his right leg. and then iran's in this patient,

this phantom limb syndrome fire and he gets relief of his pain. that's uncanny. western medicine and the technology looking at cat scan, functional mri is now catching up with a subjective experience that people have had for thousands of years. one of my favorite sayings is the absence of evidence is not evidence of absence. so the fact that we don't have these double-blind randomized controlled ironclad studies doesn't mean that it's not true. it will happen. it may take years for the research to catch up. >> ladies and gentlemen, since there's a lot of people standing, i want to give the people that are standing the opportunity to ask questions. and since we're also being filmed by c-span and they are

broadcast, if you could just wait until a mic gets to use the people on television, millions of people can here. again, we will star with people or stand and want to give as many of those people as possible a chance to cut also i just want to again thank just wanted your friend and summer that's one of my favorite people in industry for making this event happen, and that's maggie of amazon publishing. and doing a great job publishing the books better but here in the audience has. [applause] can we get somebody may be from the restricted to you from standing up all the way in the back box please raise your hand if you have a question. yes, you right there if you can. >> [inaudible]

>> the financial business of medicine. >> before you answer that question, complementary medicine as opposed to alternative. have you and your colleagues at harvard ever viewed it as western medicine being complementary to mind-body medicine? you were just talking -- >> the. >> now using the technology, the technology that has been catching up with and has been done for thousands of years and treating people well for a long time. >> right. but let me make it very clear distinction here are i'm the

beneficiary of the right total hip. i had daily, nocturnal and nocturnal pain but if i didn't know better i would think i had cancer to the bone. and i saw the best surgeon and i got a wonderful procedure. that was by the way just seven weeks ago. a week ago i played nine holes of golf. that's how good it is. so i would challenge anyone in integrative medicine to say, could you have done that? if somebody has pneumococcal pneumonia from unique medicine. if somebody has hiv or hepatitis c, you need the right medications. somebody fractured a bone, you probably need a sling and a good orthopedic surgeon. so western medicine does amazing things, and we shouldn't forget

that. somebody needs a liver transplant. i had a patient who required 100 units of blood, and survived the liver transplant and two years later ran the boston marathon. so complementary and integrative medicine has a major role in preventive medicine. how do we prevent obesity? how do we prevent depression? can we cure somebodies released? but there is in my mind a limit to it. as in that -- deepak and i will disappear. so it has a role. i've actually experienced, i had arthroscopic knee surgery, and all of the, mine useful and, and i had actually canceled the gulf i was going to play the weekend, which was very depressing. a beautiful summer, spring day

in boston but then i meet a friend and she said, sanjay, you mentioned you got released from your back pain. i had a herniated disc. by an acupuncture to ask a went and saw that lady and my knee was really hurting. it was swollen and i got acupuncture and then she got out of the car in the parking lot of the country club and kicked her foot into the air. see how good it is? so the next day, friday evening around 4:00 i had a little hiatus and i called the acupuncturist early in the morning. i went to see her, and she did the acupuncture, and i got up and you could compare one knee to the other it and suddenly the swelling was gone. i couldn't believe the. i don't understand how it happened. i called home. my wife was not there, so i called her on her cell phone and she's going to come home two hours later, doing some shopping. i went to the country club i played nine holes of golf. so i have benefited from acupuncture and things of that

sort. i'll pass it on to the back. >> i have benefited through what i practice. i don't take any medication. i've never had surgery. never been hospitalized. but i agree with what he said but i want to answer your question, because yes a very specific question about remuneration. now, sanjiv comes from harvard medical school. it's the gold standard on there are many other places like that. but here are some statistics. [laughter] here are some statistics. you can look them up. i swear i didn't make these up. between 36 and 40% of patients suffer from a disease which means disease that has been a result of medical treatment. 80% of pharmaceuticals are of optional or marginal benefit. which means if we didn't use

them, it would make a bit of a difference to the natural history of disease except some side effects and money. next time you watch television look at the commercial for any pharmaceutical whether it's a migraine, they could give you sexual impetus and it could cause death. [laughter] in between is a total panorama. also the worst heart disease is coronary. [inaudible] it doesn't prolong life in more than 2% of people but it's the most common procedure. the second most common procedure for heart is angioplasty. does not prolong life for more than 3% of people. these are alarming statistics and get these urges are being done everywhere. back surgery, 98% is useless.

hysterectomy, 95% is useless. so we are talking about huge amounts of money that are spent on procedures, okay, my father, our father would make a diagnosis come and your logical diagnosis with precision. today if you the headache you go to the emergency room, if you don't walk out with a cat scan or an mri, you are lucky, okay? because nobody has the time to do it. so we have a crisis. what we call health reform is not health reform. it's insurance reform. it has nothing to do with health. most of the expenditure is end-of-life care. nobody is allowed to die in the house. i just made my will and i said i am not going to die in the hospital. i'm not going to have any of these resuscitative procedures. i have been in committee hospital where there's the same standards don't apply an icy

doctors directing something called -- a little miner, not minor but aberration and electrolytes which if you didn't correct would cause a cardiac arrest and the patient would die. but they keep directing it even though what is there has no life there. so a lot of what we call prolonging life is actually prolong suffering to build the people who make money are the medical providers. so this is a huge problem. i discussed it with politicians. i've even brought it up to our president, okay, but we have a system -- [applause] we have a system, and this again, nothing to do with the gold standard were sanjiv practices. [laughter] we have a system where for every congressman, there are 28 lobbyists in washington. they, the only business, they

either medical industrial complex lobbyists or they are military-industrial. so you know, where do we think our country makes money? they supply arms to afghanistan. they supply arms to india. we have huge problems when the incentives for treatment becomes money, and it becomes corrupting influence. if you go to baker, what will he saw the? read. how do you think they make money? for every chemotherapy treatment that make it. am i saying you shouldn't have chemotherapy? i'm not saying they. i ask everyone here to be a difficult patient. question your doctors, get specifics, go to google, get the information -- [laughter] and you will know -- and you

will know more than the average medical provider. [applause] >> but i would say to that, don't only question the medical practitioner, the person who has the same degree, but also the herbalist. i see patients who develop what's called -- they're going to die within a few days. from liver failure. if you have liver failure, you can get dialysis. if you have severe lung problems you can be on a ventilator until things are figured out and you can be fixed. if you acute liver failure, you better pray that you get a transplant in time. and every single year the articles published in the medical literature herbs, natural, right, part of nature that kill people.

hardheaded, kidney disease, acute liver failure. my patients, a variety of liver disorders, by the way 1 billion people in would have chronic liver disease. 1 billion people in would have chronic liver disease. i ask every single patient about what do you take, and the majority of them are taking things that are never told any other physician. they're taking herbs. i say what are you taking? the list goes on and on. dr. chopra what you think about that? i said, how much are you paying? i think $342 out of pocket a month. i say, i call that a wallet biopsy. and just because it's not -- the tornadoes that happening right now which is what deepak and i will not be on tv tonight.

tornadoes swept us off the show. it's part of nature. so we have to have them we have to apply the same standards as we should to western medicine that we do to concentrate integrated medicine as well. >> it's good you ask this question, because this is a discussion that needs to take place and sanjiv is right. we have the ability to be informed these days, and you should be informed of everything. >> if we could get some it up on the stands that has a question? anybody? could we get somebody in the back standing up? the lady right behind the cameraman. no, no, no. right there. >> what do you think of shaman is him speak with this is very good question. because many years ago i don't know if i want to go into the

whole story but i was not a long story but i was ambushed by, well i will, because i hope he watches the program. i was ambushed by richard dawkins, the atheist of our times. in england and became as reporter for channel four and i was very happy with the conversation which we had, which was about two hours. then i was in the movie that he produced called enemies of reason to if you want to check it out go to youtube. there's a million hits. i was not totally offended but the reason he read economy is i said a shift in consciousness causes a shift in biology. which is a very important

statement. so your biology is different in sleet. it's different in the dream state. different now than it would be when you wer you are sleeping. it's different when you're anxious. it's different when you're angry. it's different when you feel keys, love, compassion, joy. and the traditions there's a -- i don't have time to go into right now, so consciousness, cosmic consciousness, god consciousness, unity consciousness. so what does shaman to? they shift your consciousness and when you shift your consciousness, there's a lot of good research coming out. one of the things, i used to wonder by the way what the ceiling? why do certain people in fact, and you know, while we say it's all good for preventive medicine, it's not true. you can reverse heart disease.

you can cure asthma. you have reversal of many inflammatory disorders, including many diseases. they are published studies on all of these. i used to wonder what is happening biologically? and finally i realized that what is common to all these people is a return to wholeness, a return to the word healing, holy, holistic all means the same thing. that they have biologically what we learned when we go to medical school, the first few lessons we learned is homeostasis. they are protecting us. if you inject yourself you have an inflammatory response. but if you have an exaggerated inflammatory response then you have autoimmune, allergies, all sorts of things. exaggerated inflammation tends to be a predisposing factor for most every disease. now there's a movement among

chemotherapy is to treat inflammation first and chemotherapy second. because you think of many cancers as a chronic disease. so inflammation is a protective response. exaggerated inflammation is not good. but what is the healing response? its return to homeostasis. your baseline status of dynamic non-change in the midst of change. it occurred to me that these people who are getting better, a respective of what the treatment was, whether it was meditation or shamanism or even massaged or deep and -- hypnosis are what i like to call by a regulation because the of all these devices that can monitor that. they were going to baseline state of homeostasis. okay, which is the healing response. so when you go to medical school because we are so oriented to specialization, say this is a

gastroenterologist and cardiologist. the fundamental state of our being, being, not feeling, not thinking, not doing but being at the level of being, we are human beings, we are not human thinking. at that level evolution has designed as for self repair and self-regulation. and that's what's happening in shaman is a but it's a long answer, but i felt compelled to give it. [applause] >> we are going to take two more questions. yes, that lady there and then there's one lady all the weight in the back that's waving her hand back -- we will take three questions. they are really dedicated. >> [inaudible] you each talked about being willing to dare and

take on risk. so i assume sometimes you've also had failures along the way, and i wondered what some of the most impactful failures were and how they informed your later path to success. >> i let deepak ago first. [laughter] >> i mentioned in the book a chapter where i walked out of the fellowship which is very prestigious, because i was asked a question that i did know the answer to. the question was how many milligrams -- get in the 59 papers? and i said to my supervisor, my professor, i said, i think it was 2.3 milligrams, but i'm not sure, let me look it up. in front of about 20 people, of the fellas can he said he should have information in your head by now. so i took my briefcase, i dumped

all the papers and i said you have it now. last night and i walked out of my fellowship, and he called my wife and he said your husband blew his career. he's finished. my wife was pregnant with our son, and we were earning $600 a month. i was out of the fellowship. i actually come again, read in "the boston globe" they were looking for an emergency room physician. i went there, there was a hispanic doctor, doctor gonzalez who became a great friend of mine. i said i have no experience i have a medical license and i need the money. and so for one year i worked in the emergency room moonlighting basically, and i did feel like a great failure at that time. i was responsible for my wife and my children, for the fact

that a joint a prestigious fellowship, walked out of it. and it took me a long time to realize that as long as i live for the approval of my peers and my superiors, i would not be able to do with sanjiv says, dare to dream. so it took me a while to realize that if i wanted to explore what i thought was intuitively something that needed to be explored. now we talk about science as good science. so i said i have to be independent of both criticism and flattery. it took me a while to recover from the. it was able here. >> so, i remember in the early '80s i sat down one day and i made my goals in life, and i put professional, spiritual, family, social. and next to professional i wrote on a bunch of quotes. one of them was i want to be a single author, have a book on

disorders of the liver. so i burned the midnight oil. that was my passion back then, there was no such thing as google. you had to go to i have to go to the county medical library which had the largest collection of medical books in the world and go to the basement and the subbasement and dig up the original articles published in 1970. and then i wrote an introduction. i did the table comments and then i wrote three chapters and then i sent it to five publishers. and four of them said, thank you very much but we are not interested. we already have a major book on hepatology. my fifth one from new york, they wrote back and said sanjiv, i really like your writing style. i like to come to boston and take you out to lunch. i'm thrilled and we sit down, we go to lunch and as i'm sitting

down, he says, we are not interested in your book. i said you're kidding which you can all the way from new york to take me out to lunch and tell me that? and he said, but we like your writing style. and we would like you to write or edit a book on gastrointestinal physiology which we taught all over america to second to medical students. though i had this thing, i don't know if the bank had said or it is one of my uncles have been come in every adversity is the seat of great success. and i said to myself, ma i'm going to do to books. i'm still going to get my disorders of the liver published, but a good publisher and i'm going to edit the second jet textbook. then invited a colleague of mine companies to be at massachusetts, and we will invite the entire boston g.i. at a children's hospital, union

medical center, deaconess and so on. and we did that. you know, addison once asked how does it feel to fail? he said i didn't feel. i discovered 9009 of 99 ways in which it doesn't work. when he was 57, this factory burned down, and a lot of people commiserate with them. and he said why are you doing that? all my mistakes have been burned and now i can start anew. so chilly attitude i think. we were very fortunate, deepak and i, that those values were instilled in us when we were young. >> first the lady behind you. >> [inaudible] i was wondering,

patients with chronic lyme disease committee are suffering greatly and we were hoping that perhaps maybe we could get some help for our suffering because we can't reach homeostasis. with all the alternative medicine come we've tried all the western medicine. we've tried, we are not getting well. >> i'm sorry, i'm not the right person to be answering your question. my specialty is ever disease, hepatology. i think this question would best be asked of a rheumatologist and somebody, there's a rheumatologist who also embraces integrated medicine and the mind-body connection. that would be your best bet. maybe deepak can help. [laughter] >> there are integrated on colleges, integrated rheumatologists, integrated infectious disease specialists. there's a list of all these people if you go to the website you can get more information.

i am not the right person to answer that question. >> and lastly the lady that is right in front. >> i know i'm asking a lot -- >> repeated for one more time. >> i said, i know i am asking a lot, but when you lead us in a group meditation? [laughter] [applause] >> i want to ask a question. did you meditate this morning? [laughter] on your own? [inaudible] >> so there's a wonderful engine saying you should meditate once a day, and if you don't have time to do that, you should meditate twice a day. >> you said that. >> but maybe deepak will lead the group. >> here's something. if you're not already familiar with how many people are familiar with the 21 day

meditation challenge? please raise your hand. so that's about i would say 50% of the people in this room. every three months the chopra center along with oprah winfrey, we offer this meditation on line, and the last time 700,000 people meditated together with us for three weeks. i was traveling the world in moscow and korea and latin america. isotonic people have heard of the 21 day challenge? and 15% of people would raise their hand, just like this. so i just want you to know, if you go to the chopra center meditation.com, free of charge, you will participate with the largest betterment in meditation that has ever been done in the history of civilization. there has never been -- [applause] >> okay, so i don't want to miss the opportunity of telling you

this. you can register now for free. and that's the kind of movement need to start to create critical mass of awareness. so i will lead is two minutes and then we should -- >> after the meditation is done, everybody needs to remain seated for two minutes, because sanjiv and deepak will have immediate appearance and they need to make it out. so again, please just remain seated. spent okay, why don't you, there are many kinds of meditation, transcending meditation, self aware meditation. i will start you on something that if you just start your day with your day will go a little better, okay? so close your eyes. and put your awareness on your

breath and let your mind settled into your breath. let your mind settled into your breath. don't try to make the lady. just allow your mind to settle into your breath. now bring your awareness to your heart, and ask yourself who am i? and allow any sensation, images, feelings to spontaneously surface. question, who am i?

a nap ask yourself the question, what do i want -- and now ask yourself the question, what do i want? then allow any sensation and image, feeling spontaneously arise here what do i want? and now one final question. what's my purpose and how can i serve?

what's my purpose and how can i serve? again, allow any question, allow any sensation, image, feeling or thought to emerge. what's my purpose and how can i serve? just a reminder, you don't go looking for the answer. you only ask the question. the answer is deep in your soul. just relax into your body. and please open your eyes. okay, so i said there are many kinds of meditation. this is reflection. there's a self-awareness, there's transcendence, there's

conscious choice making to their story the difference between the perceptual and the actual, but if you just do three, four minutes of reflection, living the question, first of all, you will veterans synchronicity which is many twin cities is in in response to the questions you and -- asked. so let's do this everyday and your date will be much better. thank you. [applause] >> ladies and gentlemen, i can, join me in thanking the brilliant sun chief and deepak. thank you. [applause] >> [inaudible conversations] what are you reading this summer? booktv wants to know. >> i have a couple of books.

i don't finish anyone book at one time. i keep going back and forth to different ones. "1861", about the first year of the civil war. i'm over to 1863 now and what's happening in gettysburg. which is commemorated that battle, but really getting a sense of what was happening during 1861, the first shots fired at fort sumter, and all the behind the scenes going on there at the time, what was happening around the country as it pertained to slave and a lot of other issues, obviously during that time as well, leading up to ultimately the emancipation proclamation and the lincoln administration. fast forwarding about 100 years, "fire and rain," a great book about 1969 and 1970 about the breakup of the beatles, about the emergence of james taylor,

crosby stills nash and young, from a musical standpoint, what was happening politically at the time. you know, we had woodstock in 69. you had really the remnants of the civil rights movement moving to the war in vietnam and the political unrest, can't state, all that was happening during that time, a remarkable book. ..

>> that took place just as our country was at its dawning, and it was the trial of a gentleman by the name of levi weekes who was from manhattan, and he was on trial for the murder of a woman named alma sands. and mr. weekes' defense attorneys were pote aaron burr -- both aaron wu and alexander ham hamilton. and it really was a remarkable trial that took place, as i said, a as our country was coming into being, and to have both these two rivals as your defense attorney. i won't give away the ending of the trial or the book itself, but it's a remarkable book as well. so so far those are the four books that i'm presently juggling around here and there. >> let us though what you're reading this summer. tweet us @booktv, post it on our facebook page or send us an

e-mail at booktv@cspan.org. >> booktv is on facebook. like us to interact with booktv guests and viewers, watch videos and get up-to-date information on events. facebook.com/booktv. >> next, ying ma on her book, "chinese girl in the ghetto," a telling of her experiencing moving from china to oakland, california. this is an hour and ten minutes. >> imagine being a fourth grader who lived a rather isolatedrat existence and was told about a faraway place called disneyland. she had heard exciting thingsi about it, but she really couldn't comprehend the magnitude of such a place. when ying ma and her family immigrated to the u.s. fromadin

china, she thought she was heading to disneyland. [laughter] what confronted her was a far cry from the magic kingdom. it wasn't the foreign language and culture that proved the most difficult. rather, it was the shocking racism, isolation and disdain that she encountered in our owne backyard of oakland. ying ma's story is a perfecte example of what made america great; courage to confront hardship and abuse,, determination to move past it and gratitude to a country thato made it possible for anyone to succeed and discover one's self-worth. i highly recommend that you read the personal account of her amazing journey in her book, "chinese girl in the ghetto," which she will be selling and signing tonight. ying ma has, indeed, come a long way from the inner city ofe re oakland. she received her undergraduate degree f from cornell and a law degree from hard said. --

harvard. she has served as -- [inaudible] >> thank you. corporate communications, which is the first mainland china-based internet company to list on the nasdaq. and served on the first professional staff of the congressional u.s. china economic and security review commission. she has also written article for the "the wall street journal," the international he recalled tribune, the los angeles thyme, the weekly standard, and others. currently she's a senior vice president of sd berk partner. a strategic advisory firm and policied a vierser of the heart land institute. a free market think tank. it's my pleasure to introduce mink --

ying ma. [applause] >> thank you very much. i want to say thanks to the volunteer who made this event happen. a special thanks to rita for all of her hard work and coronation in recent months, and howard, thank you for having me here. it's an honor for know tell you a bit about my book, and my story. but whenever i talk about my book, i have a tendency to think of another author, and that author is president barack obama. as you may recall, the liberal media raved about barack obama's writing ability in the 2008 election. back then, senator obama's résume was quite short, and his supporters often would say with

a straight face, that he was just marvelous because he wrote two marvelous books about himself. at first i thought it was a joke. when senator obama actually became president obama, i realized it was no joke at all, i decided that i seriously needed to get with the program. and start believing in the dreamy barack obama world of yes, we can. so i thought that what i needed to do was to write two books about myself, and maybe i too can be president of the united states. [laughter] [applause] so i sat down and wrote a book about myself called "chinese girl in the ghetto." when people asked me what the book is about these days, i usually politely tell them it's about my family's journey from

communist china to inner-city oakland california. it's about my journey of getting to know freedom. what i'm really thinking. usually what is really on my mind, i need to hurry up and write another book about myself. and why do, maybe i can go to all of those places that barack obama has been able to go. yes, we can! [laughter] i'm joking, of course. i was not born in this country, so i can't become president. [laughter] [applause] donald trump ceptd my hopes up for a long time. [laughter] he kept telling me and everybody else that barack obama wasn't born in this country either. so when barack obama finally released his birth certificate in the 2012 elections, i was

pretty devastated. all of my hopes for the white house were dashed. it's a feeling that i'm sure senator marco rubio will become quite familiar with in 2016. in any case, when it became clear that writing another book wasn't going to do anything for my political ambition. i decided to focus on telling people about the book i have written, and i think it's a book that was worth writing for -- its own sake. let me team you a little bit about it. my story is an immigrant story. a legal immigrant story. [laughter] [applause] i was born in china at the time when the country had been devastated by decades of to tolltarian communist rule. my family lived in a apartment that had no running water, no modern toilet facility, no

washer, no dier, -- direr and none of the amenity we take for granted here in the midwest. we live in a place that was considered to be quite modern and quite enviable for folks in china. we lived in a city and didn't have to do back breaking farm labor. back then, everyone who could leave china for america wanted to leave. everyone who couldn't leave wanted to leave too. when if my family had the opportunity come to america, we immediately took it. we moved to oakland, california, knowing almost nothing about it. we showed up there because we had relatives and we wanted to be close to our family members. yet, instead of finding an america with the streets were paved with gold, we found crumbling schools, unsafe

streets, and racist people. that was because we had arrived in inner-city america. the heart of the welfare state. one by one the horror of the ghetto showed themselves to us. poverty and urban decay plagued our new city. store fronts had shattered windows, streets were pockmarked with pothole, bridges and tunnels were splashed with graffiti. the streets downtown even near city hall were often streets that smelled of urine, homeless men and women aggressively pan handled. that's when they were being nice to you and accosted tourists and residents alike. crime plagued our new city as well. drug dealing seemed more prevalent at time than employment. muggings took place in plain

sight. and gunshots rang at night regularly interrupting my tv watching. racism also ruled my town. asians and didn't matter if we were chinese, vietnamese, we often only had one name. and that was chinamen. that was the case at school, on streets, on the bus, and seemingly everywhere and anywhere. on the sidewalks, teens had a habit of entertaining themselves by creeping up behind frail and elderly asian immigrants and frightening them by screaming at the top of their lungs their worst imitation of the chinese language. more often than not, racial slurs were backed by the threat of violence. and sometimes followed by violence itself. and because the racism of the perpetrators simply did not fit neatly in to the politically

correct narrative that our culture so often prizes, main stream america paid no attention or simply looked away. in the ghetto, there was a general break down of law and order. and overwhelming absence of personal responsibility. it was prevalent and supposed to help. it only made the place even more dysfunctional. it provided food stamps but it could not stem hunger. it offer welfare checks but could not promote economic growth or create jobs. it excused laziness, turned a blind eye to gang banging, and con condoned a break down of the family unit. worst of all, it insilled a sense of entitlement in the subject, and took away their pride, sneered at their dignity.

thankfully, for my family we didn't participate in the welfare state. this was in part because we spoke almost no english when we -- showed up in america. we had no idea how to apply for welfare benefits. [laughter] we didn't even know that welfare benefits existed for people like us, and back then they definitely existed because this was the day before welfare reform of 1996, and poor illegal immigrants in the country didn't have to have been here for five years before they became eligible for government money. maybe we didn't take advantage of these welfare programs simply because we weren't that bright. we never bothered to even inquire about the benefits because it didn't occur to us or hasn't occurred to us by come together united states meant we should hold out our hands and

ask the federal or state government for money. perhaps our ignorance was actually a blessing in disguise. that meant we had to fight our way out of poverty the old fashioned way. we worked. we had limited financial resources, so my parents worked at menial your -- jobs, long hours in the beginning for less than minimum wage. we wore clothing from good will or handed down from our relatives. we used second, third, or fourth hand furniture, and at first my brother and i each slept on half the bed. he slept on the box springs. i slept on the mattress. i think he insisted i got the better end of the bargain. there was hardship and shared sacrifice. the mother who was once a well respected schoolteacher became a

seam stress at the sweat shop. the father who was once a senior mechanic trailed by the group of apprentices became the kitchen help for a chinese-owned restaurant where the owners regularly verbally abused their employees. the children studied day and night instead of hanging out on the streets using drugs or otherwise poorly behavior. our family saved for homeownership instead of splunging on vacation. >> my brother and i learned english more quickly than they did, we took them to the hospital when they were sick. we filled out job applications for them when they were looking for work. we accompanied them to the unemployment office when they were laid off, and we haggled with the utilities companies

usually with adults many years older than we were when they overcharged us. we did not demand that the government level the playing field by giving us handout or free byes. we accepted that life was unfair, and that not everybody -- not everyone could be born rich or even born in this country. we certainly didn't occupy public buildings or parks. we didn't urinate on the street. we didn't violate city ordinances. we did not destroy public park property. or steal private property even when things didn't go our way. we thought it was wrong to feel entitled to government already guess or other people's money. we also didn't demand that america somehow give us preferences in the form of racial and ethnic quota. in fact, being asian in

california pretty much meant we didn't receive any of thoserefe. but racial quota and preferences were dolled out quite lavishly to sons and daughters of dennists, doctors, and other middle class professionals who belonged to racial categories that were far more in fashion in our society. regardless, in the end we prevailed. we prevailed over the welfare state. we got out. certainly we didn't do it alone. the kindness of the american people has always impressed me. i think it's something that impresses all immigrants to this country. and we remain grateful to those who offered a helping hand and a warm smile. repeatedly, when i was reading a piece in the "the wall street journal" written by governor jeb bush, i thought of my family's journey out of the ghetto.

he said "today the sad real city if you're born poor, if you're parents didn't go to college, if you don't know your father, and if english is not spoken at home, then the odds are stacked against you. you are more likely to stay poor today than at any other time since world war ii." what struck me about governor bush's piece was that all except one of his prerequisite for being condemned forest fire poverty applied to me. fortunately i know my father. but i was born poor. my parents didn't go to college, and english was not and still is not spoken at home. the odds were stacked against me. so like barack obama has been eager to harp on the odds for political purposes, in the narrative he has been pedaling for the four to five years. the little people at the bottom of the society don't get a fair

shake. millions and billions, according to him, or the richest 1% have edged out everyone else from opportunities for success. america's economy has become a -- for the privilege few, and unless government barack obama's government intervenes heavily, the poor and the middle class will never thrive. in this paradigm, in mr. obama's paradigm i had no business getting out of the ghetto at least not without receiving a welfare check. this is because barack obama doesn't just peddle the benefit of the welfare state. he really ped dahls the welfare state mentality. the mentality is even worse than the welfare state itself. it absorbed individuals of personal responsibility. it confines them to grievants and encourages even justifies their sense of entitlement.

since the election of last november, republicans have been hyper ventilating about how much more effectively mr. obama and his party can relate to the urban poor and minority. he seemed willing to point that the odds are always stacked against the poor. it's not supposed to be easy to get out of poverty. that's why you work harder, you purr -- pursue your stunt more aggressive and learn to be more nimble. it's a reality that conservatives should be ashamed or afraid to point out. in the conservative bar dime, in our paradigm, free men and women make choices. we take responsibility for our lives, and we extract ourselves from less than stellar circumstance.

that was how i got out of the ghetto. despite the odds. unfortunately the el welfare state didn't just exist in the ghetto. it's plagued with racial strife, a break down of law and order. if you were to take away the latter two and the high crime rate, or the racial strife, big government is all over in this country. and find the welfare state everywhere. the welfare state really isn't just about welfare. it's about government intrusion from the top and entitlement mentality from the bottom. we live in a country where collectively we spend more money than we have. we are the takers who are like to take more from the makers. we have a president who uses every opportunity he can to land base the successful, to tell

americans that fairness and progress can only occur which those who have the money given more via higher taxes to those who have less. taking and spending other people's money is what barack obama likes to call our shared commitment to each other. americans agree with him. at least enough to reelect him as president last year. unpleasant as it may be. the real city that it is always -- always difficult to convince people to say no to free money. it is always difficult to convince them to opt for the uncertainty of free market and free enterprise and walk away from government subsidizes. i may have emerged from the ghetto without received welfare benefits. but i think it was purely an accident.

if i had known that welfare programs existed and my parents qualified for the welfare programs, i would have brought them myself to the relevant government officer -- offices, filled out the application, served as their translater, and anal 10, whatever it was i would made sure they got some free money. i never had to do that in oakland. i had family and friends -- and if my parents were to call qualify for welfare programs today, i would still be the first to hep them apply. the truth is, most people find it very hard to say no to free money and most simply don't. we all respond to monetary incentives. of course, we know that there's no such thing as free money.

our big government is funded by people who work, people who create wealth, people who pay taxes. and it is funded by money we borrow by a national debt of approximately $17 trillion. we also know barack obama's welfare state didn't just hand out welfare check or food stamps. it also hands out goodies ranging from amnesty for illegal immigrants, free contraceptive for women. if you're at the receiving ends of those goodies, it's very hard to say no. so the key is not to be giving out the goodies in the first place. i know i'm supposed to provide an uplifting story tonight. the truth is we simply cannot defeat the welfare state on our own. in the grand scheme of thing it is makes little different that my family and i made it out of

the ghetto without receiving welfare benefit. we got lucky and able to escape the tentacle of the welfare state. it to truly defeat the welfare state, we would have to defeat the welfare state mentality and roll back policy that incentivize dependency and foster a sense of entitlement. and when we do that, we will have a real story to tell about defeating the welfare state. that would be a truly great story. until then, i would merely leave with the greet my book. it's from the introduction. in china i couldn't avoid the randomness, or the weight of authoritarianism. i remained upbeat, cheerful, and happy. in the ghetto, i forgot what it meant to be joyful, but even in

the ghetto, people have a chance to walk away from some of the worst attribute of the free society in to the finest virtue. it is disbelief that lies at the heart of my journey of getting to know freedom. i hope in the end freedom will defeat the welfare state and the entitlement mentality. thank you. thank you very much. [applause] those who would like to follow my work. it's yingma.org. you can find my writings and interviews there as well. >> thank you. and for those of you who have been here before. you know for the q & a we'll have people passing out cards like you see over here. and over here. and we'll take them to the person in the back who will read

them for the speaker. so if so you questions, raise your hand. and we'll get a card. thank you. >> yes. i am. [inaudible] a child's life in china -- [inaudible] between the age of 8 and 18 -- [inaudible] not necessarily. i think that every -- i think that for people of my generation in china, no matter how happy they were in china, they were gavin chance to come to the united states they would come. and having gone through what i went through in oakland, i don't regret coming to america. i think that one lesson i would draw is that freedom isn't supposed to be easy just because

you show up in a free society, a wealthy free society doesn't mean there are any guarantees. and so a success is not going to be there waiting for you. and i think that for people who live in communist countries, like the former soviet union, for instance, they would rather have the opportunity to fight for that freedom to fight for their success and than confined to a lifetime of immediate of course if i and hopelessness. i think it's hard to be an immigrant no matter what. it's hard to leave your friends and family. it's hard to leave a society that you're familiar with. and i think that for kids leading china today or any other country, that's going to be the case no matter what. but in this country, i think the opportunity is always beckon. it continues to beckon all kinds of people.

i think policies that promote economic growth, policies that are business friendly. i think those help a lot. i think cmmu >> i think those help a lot. i think community groups and adults who actually teach childrenw not to think with anh entitlement mentality helps as well. i think there are lots ofh things. i think part of it is that the government in oakland tends to be very anti-free market, very -- and it has not alwayse been all that strong on law andd order. those things are very important if you want a stable environment. but at the same time, you can'tn rely on the government to do everything, and so part of the

problem with oakland is that the -- at least when i wasrowi growing up there, the mentality really was an awful one. and until you get at the root of that mentality, until you teach kids motto think that wayt anymore, things aren't going to change all that much. much. >> to the comment you made is how would you -- how someone trapped in the mentality get out of it? if you're a friend of yours? >> well, i would say a few things. number one, don't make any excuses for yourself. when you grow up in a poor environment and unsafe environment, when your family doesn't have a lot of resources, it's very easy to make excuses. it's easy to say i can't do this. i can't do that, i can't go places because my family simply hasn't provided for me. and or, you know, my people are oppressed or whatnot. don't make any excuses for

yourself. that's step number one. step number two, don't blame others. there are certainly bad people out there. there are always going to be people who don't necessarily wish you well, but there are so many people who will always be there to lend a hand. .. that is really just how it is and i grew up in it, his country before it liberalized its

economy. everybody had the same number of opportunities which was not very many. so, the key is in a society that does provide opportunities you have to take advantage of them and you have to apply yourself. >> how long did it take your family to get a visa to get out of china? >> we -- it took approximately four to five years. in fact come to i wrote an article recently for "fox news".com called a legal immigrant story and you can find it on the web site trade in that story i describe how incredibly hard it was to jump through the hoops to actually do everything america asked us to do in order to come here legally. what's interesting is that these days you constantly hear people say that well our immigration system is broken. we wanted to come here legally but we couldn't or they were

just too many obstacles. the truth is lots of people actually stand in line and wait for a very long time man they do that because they respect the rule of law and they also respect the country that they wish to adopt as their home. in my story, the story i wrote for "fox news".com a story entitled a legal immigrants story i talked about that process. i talked about how hard it was my remember seeing my mom come home from the american consulate and she came home crying. i knew that our days for immigrating to america had to wait a little bit longer. in our debate about immigration reform we should not forget those people who are legal immigrants and absolutely not let people talk us into forgetting the distinction between legal and illegal immigrants. [applause]

>> how did you get from a poor inner-city education to cornell university? >> well, i read a lot. they -- when i first came to this country i didn't speak english so what i did was i spent his summers reading chinese novels and they were very good novels but most likely my parents if they knew what was in those novels would have said they were really inappropriate for my age. they were written by a very famous novelist and asia and you know i spent my summers reading those novels. one because i didn't have access to books like that in china when i was growing up. back then under communist rule people weren't really allowed to read anything colorful or exciting. you read a lot of things that had a lot to do with communism and why communism was great. and as i got a little bit older

and once i began to learn english i handed up spending a lot of time reading english books. it was terrible for my eyesight but the great thing is that books take you to all kinds of places that you can't even imagine and once i started digging into the books i realized there was a whole new world outside of the ghetto and i was eager to get out as soon as i could. one way for me to do that was to study as hard as i could. >> what the your thoughts about the gang of eight. [inaudible] >> well, i didn't seem too fond of the idea of marco rubio running for president earlier so i think that probably gives everybody a hand. first of all i hope it fails.

[applause] at least i hope it fails in its current form. there were all kinds of efforts by different senators recently to try to make amendments to the gang of a proposal and to make it better to strengthen the enforcement mechanisms but those amendments were all shot down so in its current form it's a disaster. it has now gotten to about a thousand pages long. i actually wrote another article about this. it's called emigrating to america is not an entitlement and it addresses many of the flaws. [applause] and it addresses many of the common misperceptions of what immigration is about. i have a number of disagreements and i suspect that those of you in the audience do as well. i think that my number one disagreement with the bill is

that it provides provisional legal status to approximately 11 million illegal immigrants who are in this country before and a significant and meaningful measures of enforcement actually take place before the border is actually secure. i think that is a huge problem. but in addition to that given that i've gone through the immigration process, i suppose i have a little bit of a problem with people saying that while america's immigration system is broken and hence we just get to come here legally. i am sure that many of you believe that our tax system is broken too and that you all believe that you don't want your tax dollars to go to our bloated welfare state. but it doesn't mean that you can stop paying your taxes and if the irs were to come after you you would say well i believe our

tax system is broken and hence i stop paying. but that is however the situation we have with their immigration system. it is broken and everybody acknowledges that, let's fix fit but somehow it doesn't affect its broken all these people have a claim to being here because they just want to because they aspire to be american. i have a number of other disagreements and i would point you to my article. i think the title tells you how i feel about this issue. >> how do explain the chinese immigrants to come here resume a bully to -- to join and vote for liberal democrats? politicians are here from china. [laughter] >> i would say a few things.

i am actually not sure -- i'm not convinced that people who escape tyranny from china come here and immediately start voting for liberal democrats. some of them probably do when they become citizens but i haven't seen enough studies that say the anti-communist folks in fact are more likely to vote democrat than they are to vote republican. what i do know is that oftentimes when you get to the second or third generation chinese-americans they do tend to be less conservative than their parents because the immigration experience is further away from them. the hardships that their parents with their grandparents had to go through aren't orange is relevant to them and many of these kids you know, apply themselves and end up as very good colleges. at these colleges what happens is they get brainwashed by liberal professors.

[applause] so i think that's part of the problem. what is also part of the problem is that folks who tend to be very politically active in the asian community a lot of the easy to do it on the national level tend to be a lot more liberal than the people down the street than your average asian-american particularly more recent immigrants. for whatever reason these asian-american activists have decided that unless they adopt the rhetoric of the left-wing that somehow they have failed. many of these activists don't necessarily. >> the native languages of their respective communities. they don't necessarily know all that much or for all the details of the people or all the difficulties of the people they claim to represent and in many ways you know you can see a

parallel between the asian community in the black community. lots would say jesse jackson or al sharpton publicly don't represent their points of view. someone like former representative allen west would in fact have said that quite a bit. in the asian community it's an issue that is not as pronounced. i think because they community probably isn't as politically active as a whole but there is also that this cannot from those national self-appointed spokespeople a disconnect between them and your average asian-american citizen simply because the former doesn't always understand the latter and the latter tends to be a bit more conservative. the third thing i would say is that i think immigrant communities tend to be more pragmatic and because china has undergone 30 years of economic

liberalization it's not the same communist country as it used to be. it still is very repressive in many ways but i think for a lot of younger chinese don't necessarily know those awful days, at least they don't know intimately the awful days of the cultural revolution or those days of starvation under chairman mao. and so sometimes they actually can be very nationalistic. so instead of bearing hostility toward communism they might actually be very mad -- nationalistic toward china. i think overall the community may not be as ias ideological. for instance the cuban-american community and when people are less ideological and more practical if you give them a promise of a whole bunch of goodies contest they are likely to respond that way. if mitt romney says i'm going to cut the size of government and

i'm going to cut -- i'm going to reform entitlement programs and i'm going to do tax reform but the other side says well that just means he's going to cut your benefits and is going to take away medicare and so on the pull respond to that. a lot of folks these are pocketbook issues and part of it is that they could very well swing the other way if you have someone who actually is a more charismatic political candidate, someone who can speak more direct you to their concerns. so, i have given you a whole bunch i guess. [inaudible] >> i think immigrants i think they are all over the bay area. obviously it's full of immigrants.

there are lots of community groups. i think community groups whenever a particular group is close to the local level i think they tend to understand the needs of the people in that community far better. i mean there are lots of things. when i was a kid living in oakland one of the things i benefited the most from was approach i'm called the arthur ashe tennis program. i think this was something founded by arthur ashe. he was a tennis star. he was the first african-american to win wimbledon and the founded this program for inner-city kids to learn to play tennis and to give them something to do so that they wouldn't be out on the streets and to have coaches teach them sportsmanship and self-respect. that was where he learned to play tennis and the folks who taught them that program didn't get paid all that much i know.

if they were to give private tennis lessons they would be paid a lot more and that is something that i brom .. folks. there are ways to -- even if you are let's say to donate clothing or money i am sure there are lots of -- out there to serve immigrant communities. you know their needs range from everything from food to clothing or sometimes to do translation ,-com,-com ma translation help to things like maybe sometimes they need legal services and can't afford them. there is a wide range of services that folks need and i think there is no shortage of groups here in the bay area to try to help them. getting involved with one of those groups is one way to do it. another way is i think a lot of

times it perhaps doesn't even require participation in some sort of organization. i think just being kind and being decent to somebody and trading in immigrants just like he you would treat one of your friends, that i think that often goes a long way to make an immigrant feel at home in this country. and i think that would be a good place to start. >> you have any ideas on how to encourage young people in the ghetto to seek role models from successful people and other individuals with backgrounds that might help them? >> you know what, i would say especially to people in the ghetto there are role models everywhere. i think our culture has just gotten so politically correct that we often make it seem like if somebody does not share your color or your ethnicity or your cultural background that somehow you can't look up to them. we are constantly saying we have to provide a role model for a

particular community. we have to find people of that race and that gender, that ethnicity. i think it's great to find role models of any gender or ethnicity or culture or race. i think for young people one of the things that adults or authority figures who deal with young people a lot what they shouldn't do is to inculcating young people's heads that somehow the only people you can look up to must look like you are sound like you. that is simply not the case. you know when i was growing up, to one of the instructors who was the kindest to me was an african-american instructor. he taught me in fifth grade and unfortunately has passed away since them. but i remember that you know this is my second year in the united states and they knew how to do math really well but i didn't speak english all that well and i didn't notice that i

worked really hard to learn. i carried this pocketbook dictionary with me everywhere so that if any time i countered a word or a phrase i didn't understand i would look it up and see what the chinese translation was. he went out of his way you know to help me acclimate to american society but also to encourage me to do better. it didn't matter to me that he was not chinese. it didn't matter to me that he was black. he used to tell, in the class that i had with him, most of the students in my class were black. he used to tell the black kids of the time that they needed not to slack off and stop making excuses. they needed to work harder. it was great that they have a role model i cam but just because you don't have a role model that shares your particular color doesn't mean somehow you should stop looking. there are all kinds of people and i've seen all kinds of folks

who have been willing and able to mentor people who didn't share their gender ethnicity or cultural background. i think actually, i think the mentoring goes both ways. people who mentor are willing to do it but you have to be willing to open yourself up to people who wish you well and want to help in the first that this to a bout those people who may not look like your sound like you to do that. >> do you have two or three specific recommendations for the city locally to improve itself? [laughter] >> you know it's interesting, that i haven't thought about that. i haven't lived there for a while and i know the city has changed quite a bit.

you know, and i remember under mayor jerry brown i do remember that a number of improvements were were made in were made and i appreciated those improvements. i sort of feel like i've been gone for so long that this question probably would be better answered by a resident of oakland who really have to deal with the city government as well as other aspects of the city. i would say that i mean for me when it comes to making changes in inner-city areas i think it's very crucial for those areas to become business-friendly and two in courage small businesses to encourage entrepreneurship and i have to go back to the mentality

the mentality among the city's residents fostered not just by people in government but also their families and churches and communities and your schools. i think for those cities that have inner-city areas that require a lot of help, i think getting to the root of that mentality is very key. >> many immigrants have dual citizenship and allegiance to the country from where they came. our system recognizes dual citizenship. do you think this should change? >> i think at the moment dual citizenship is not for everybody. dual citizenship is not allowed for people who immigrated to the u.s. from china for instance. usually i think dual citizenship is only allowed for those

countries that are friendly to us. so if you are a swiss and u.s. citizen most people would like to think that you are going to be homeless. and you know, god my understanding is that if your home country as a country that is considered to be hostile to the united states for the most part the government won't actually allow you to hold dual citizenship. you either stick with a citizenship that you are recently had or renounce it and become an american city which makes perfect sense to me. [inaudible] [laughter] well, to that would go back to what i said earlier. i think strengthening enforcement mechanisms is very key. until you do that the rest of

the talk is pretty much just talk. if you're not going to enforce our borders and if you're not going to deport people on a meaningful basis so for instance right now there is a union within the immigration and customs enforcement's unit and those officers complained that what the obama administration won't let them do are two things that are very crucial to their jobs. one is to actually detain folks who are here illegally and two is to deport them and the obama administration has adopted this policy that once you are here unless you have committed some sort of serious crime i mean the administration is not going to spend that much time supporting you or spends too many resources

on things like that. when you have an immigration policy that really doesn't have a whole lot of teeth and when people don't think that there is severe punishment for severe consequences to coming here illegally, then obviously we have a broken system. i do believe that we should make this country far more friendly to tilt laborers from oversees. there are lots of people who would divide a lot of help to our economy who would provide their skills and their expertise and a three-year folks like that get what is called and h.b. one visa. there's a small quota for them and usually all the employers in the country that would like to hire people like that do want to have visas like that at the very beginning of the year and that was the case this year. they sort of hit the limit of

those visas in january i believe. so it actually makes a lot of sense to make it easier for scientists and mathematicians and others with high skills to actually come here and provide their expertise and help our economy grow. i think that we need to get away from the identity politics that is often being played on immigration policy. unfortunately it's very hard to do because many illegal immigrants the largest group of illegal immigrantimmigrant s in this country are hispanics and within that are mexicans. it's often very hard to separate the two but the key is we actually need to have people who would be willing and not afraid to say that just because we want to enforce our immigration laws

and just because we want to secure our borders does not mean that we are bunch of racists. and i think that is actually a tone republicans are constantly talking about how we got the tone wrong in the last election. well, one thing we should do is to set the right tone and the tone is we should stop actually letting people characterize conservatives as racists just because they want to secure our borders. i think rule of law something that conservatives have always cared a lot about and we shouldn't give up on that poor seabed to the other side just because we lost the election and by the way even if we did have the hispanic vote in the last election romney would not have one. anyway i think that there are lots of folks who have thought very intelligently and thoroughly about immigration

issue but what we do have right now is obviously a system that doesn't work very well and we also have a proposal that is very imperfect. so we need to get beyond that. >> have you ever considered running for office? >> didn't you hear me earlier? i was thinking about running for president and that was why i wrote this book about myself. [laughter] and then of course since i'm not a natural-born citizen it turns out i can't do that anymore. >> as conservatives should we stop using the term illegal immigrants? >> no, absolutely not. [applause] be what do you think -- this is his sixth day that obama got 70%

of patients votes and that is obviously not chinese but chinese filipino japanese korean whatever so what would you think would be the appeal to win this group of people to the conservative republican side? >> yeah, i have been asked that question a number of times since the last election. i don't think anybody has done an extensive polling or any substantive studies in the asian community to ask people why they voted the way they did. i think everybody who has talked about it really has just been taking a guess and i offered a few educated guesses. one of which i mentioned earlier which is that i think second or third generation asian-americans oftentimes are a bit -- they have a tendency to be a bit more liberal or a much more liberal than their parents or

grandparents. i thinking governor romney's case my guess is that it's quite hostile that his tough rhetoric on china ended up turning off a lot of folks in the chinese community and like i said earlier these days there are a lot of chinese immigrants who are very nationalistic about china. and there are lots of americans who disagree with governor romney's proposals on what to do with china. i don't agree with him 100% on many issues but i think if you are somebody who is very nationalistic about china or your heritage and you hear one of the political candidates constantly talk about china and getting tough with china comes and i have no doubt the governor romney was talking about getting tough with the chinese communist regime but oftentimes voters don't make that distinction. they might think that governor

romney is being anti-china and they might think maybe he is anti-chinese. that is simply a guess. i think somebody would have to to do is study and actually ask folks why they voted the way that they did. in addition to that, as i mentioned earlier governor romney also promised that he would roll back big government. i voted for him and was certainly counting on him to do that but the immigrant community is not insensitive to monetary incentives. as i said earlier there are lots of immigrants who do have failed themselves of government freebies. these days most people i guess and not as ignorant as my parents or my family was when we came here. people nowhere to go to find free money and people nowhere to go to apply for welfare benefits and people know what to do to

make themselves appear eligible before government bureaucrats when they need to apply for those benefits. and i think that many of those people probably to vote and when they hear that one candidate is going to roll back the government they probably think you know that would affect their pocketbooks and that would mean fewer benefits for them. i know many people feel the asian community is more inclined to be conservative than a community that is hard-working and industrious. in many ways it is true but just because that is true doesn't mean that people don't want free money or would say no to it. if you are a hard-working immigrant did you come here poor and the government offers you free money you are going to take it. it's very unlikely that you would say no and i think that actually probably has an impact on how people float as well.

>> this maybe is a question of optimism versus pessimism. if you look down the road 30 to 40 years what do you think the state of the welfare state will be? >> i think we need, i think conservatives need to start winning some elections. they weren't need to run candidates who are charismatic articulate a viable and conservative free-market thinkers and that we need to take back the white house. we need to take back the senate has if the government continues to be -- our federal government continues to be run by people who are big government types the welfare state will become ever more bloated. we will be staring down a path that greece is currently on and our society will become a huge entitlement state.

so i would say i would like to be fairly optimistic. i would like to think that there are viable conservative candidates out there who can articulate a message without compromising on their principles. and you don't think there are lots of governors out there right now who fill that void. i think the key thing to do is to start winning some elections and we can turn things around. [inaudible] >> i have written about that too i think what people say is folks like president obama and liberal columnists like thomas friedman with "the new york times" as

well as other big government types ever since the financial crisis hit they have been advocating heavy government spending. they wanted more infrastructure spending. they wanted more funding for renewable energy projects. they wanted all kinds of things and when they got pushback from free-market types and folks who believed in limited government they started using china as their example and they started using china to go to conservatives into sort of this position of having to adopt their rhetoric. china as many of you know has grown dramatic way in the past three decades or so. they began undertaking economic growth in 1978 and they opened up their economy to the world. but it's still a communist country and still politically oppressive and a lot of things

are still run by the state which is why commentators these days like to refer to china's economy as a state capitalist economy. folks like barack obama for a long time he kept pointing to the roads and bridges that china was building and saying why are we just sitting here watching them build these roads and bridges, the airports and other big infrastructure projects while our infrastructure here is crumbling? he also says why are we sitting here not willing to give our noble energy companies funding while china is just shoving money in these companies directions and china has gotten to a point where it now dominates the solar industry. so for liberals china is kind of of -- when they look at the chinese government they see something that they would love to have which is the ability to

spend freely without accountability to voters. it's very exciting to them. there is no meddlesome congress. [applause] there aren't any tea party types you now and so but when i've written about this topic but the research shows is that china started growing dramatically largely because it introduced more free-market mechanisms and to its economy not as it became more status. the chinese economy today is much freer than what it was 32 years ago when they first started their economic liberalization revolution and numerous chinese reform minded folks whether in government or

small and medium-sized enterprises in china they all recognized at the hand of the government is intruding and interfering with the economy and it creates all kinds of inefficiencies. it creates or supports monopolies that in a fit lots of large state-owned enterprises and it suffocates certain industries. what a lot of reform minded chinese officials and economists what they advocate is that they would like to see further economic reform. in fact this is something that the new chinese leadership has been talking about. this is something that they would like to see too. they believe that in order for their economy to grow in the long run to really get to a modern first world economy they will have to implement some changes. if barack obama, he certainly

has talked a lot about becoming more status like china but what a lot of chinese recognize if they actually need to become more free-market oriented. so i would say and this is something i say all the time. we shouldn't listen to barack obama for that matter. [applause] >> to believe that many first-generation chinese the most conservative ones do not vote? >> i am not sure about that. here in california we make voting easy for chinese immigrants. there are ballots that are translated into chinese so even if you don't speak the language you can go get yourself a chinese ballad and fill in the circles. obviously that is not the case in other states with smaller immigrant populations but i

would just say here in california it's very easy for immigrants to vote. so many things are bilingual and multilingual. whether immigrants actually vote or not is a different issue. i haven't seen the polls are the studies so i'm not totally sure about the voting rates within a particular immigrant population but i mean i'm sure that like other in america there are lots of people who don't vote so it wouldn't surprise me if lots of first-generation immigrants don't vote either. >> you think america is still free? >> i think lots of things are relative so when people ask me that question i usually ask compared to what? there is an index of economic freedom and so every year hong

kong and singapore come out of the very top of it so compared to hong kong and singapore are economy severely is free but when it comes to political freedom or other measures you know we certainly are much freer than modern day china and much freer than russia for instance and then i would say that you know i continue to refer to our society is a free society. i think there are ways for our markets to be freer. i think that there is a lot of government intrusion that interferes with that. but in recent years as a result of the financial crisis and the economic intervention that has taken place economic activity certainly has gotten freer certainly with the passage of obamacare but i remain hopeful

that some of those things can be rolled back. [applause] steo follow-up question. you'd came from -- which is neighboring of hong kong. how does the united states freedom of economics compare with hong kong? >> i think hong kong has an extremely free economy. hong kong is constantly ranked by conservatives or free-market research institute says he did the number one or number two freest economies in the world. when you talk about it that way our economy definitely is less free compare to hong kong's. see i think that's it e-rate thank you. >> thank you so much. it's been an honor. [applause]

than american diplomats. >> this weekend on c-span, nicholas burns on the history of u.s. diplomatic efforts in the middle east. saturday morning at 10 eastern on c-span2's booktv. how would you define the american dream? the dream from the great depression through the 21st century saturday at 7:30 p.m. why change this to the truth is more exciting? true tales of the founding fathers sunday at noon eastern. >> now a discussion on the public health care system and whether it can handle a disaster either man-made or natural. representatives from the centers for disease control and prevention, and the american public health association joined

state government officials in this hour and 40 minute discussion hosted by the alliance for health reform. >> good afternoon. my name is ed howard. i'm with the alliance for health reform, and i want to welcome you on behalf of senator rockefeller, senator blunt, our board of directors to this program on how well america is prepared to deal with both natural and man-made disasters. and i should say up top, this is not an intellectual exercise. and i want to illustrate that i stealing a sentence from a letter written by one of our panelists today, doctor ali khan of the center for disease control and prevention. a couple years ago transmitting the nation's first national strategic plan for public health

repaired is in response, he chronicled what was then recent major disasters, and this is the verbatim quote. in the last five years alone, national and global health security has been threatened by incidents including hurricane katrina, west nile virus, h1n1 influenza pandemic, bacterial contamination of food by e. coli and salmonella, the deepwater horizon oil spill, the haiti earthquake, and following cholera outbreak and the japanese tsunami and subsequent radiation released. end of quote. that's a pretty breathtaking listing for only five years. and today we're going to maybe speculate on what the next five years will bring and examine how well prepared are to deal with that list. we are pleased to have as a partner today in sponsoring the briefing, the robert wood johnson foundation, which has

been helping americans enjoy healthier lives and get the care they need for 40 years now. and we are very lucky to have with us, to co-moderate the program, dr. john lumpkin was a senior vice president of the foundation and director of its health care group. and i should note that before joining the foundation, he directed the illinois department of public health for 12 years, so he brings a great deal of experience and expertise to today's discussion. john? >> thank you for -- now i am on. thank you all, for coming. this is a very critical topic. from my viewpoint at state of illinois, i was able to actually charge with participating in response to a number of disasters, some of which, many

of the people outside of illinois might not have been familiar with but we had major flooding in 1993. and i became quite interested in that because my background before it came into public health was in emergency medicine. and as someone who's been involved in doing disaster planning for most of my career, i began to bring that is part of what we'r we are doing in public health. but i can tell you that that is a really challenging task. one of the things back in the late 90s that i felt was absolutely critical, and it's more commonplace now, is we would have a molecular biology lab. up till then we will would basically grow cultures in the lab. you would see what they may show in a day or two, and trying to track an outbreak of disease was really challenging. from molecular biology lab you can do dna fingerprint. i thought that was something that was really important. so i had a conversation with a beer of the budget and the governor's office when i did my annual budget and they said,

yeah, that sounds like a great idea. next. in the following year we had the same conversation. then we had september 11. in 2001 we rapidly set up a molecular biology lab. fortunately, because with thousands of samples that people have sent in to the lab because they were concerned that this was going to be anthrax. now, that could be the end of the story. we increased our preparedness. but in 2002, there was an event that occurred in a small town outside of springfield, illinois, where a bunch of people had come to this music festival and they started coming down with e. coli. we had the capability to the fingerprinting that would enable us to track individuals who are sick and it scattered across the country to this one particular site in one particular type of

food. then in 2002 when west nile hit our state the fact that we had a molecular biology lab enable us to be able to respond to the outbreak and to run thousands of deaths of people who thought that they may have been infected with this disease. this is why we at the robert wood johnson foundation feel that this particular issue of preparedness is so important, because it's not just about responding to the major disasters that make the news. but that preparedness is also about making sure that our public health system is ready to deal with the small disasters. the small difference they can have an impact on how of the people are and how they live their lives. so we are pleased to be cosponsors of this event, and to recognize that what we're going to be talking about has an impact on everyone's lives as part of beefing up the public health system. at the same time as beefing up the ability of this country to

respond to major catastrophic events. >> thanks very much, john. let me just do a little housekeeping here. you have written materials in your packets, including a graphical information about each of our speakers are power points presentation, hard copies, if we have them. if you're watching on c-span or you're watching the webcast of our briefing on our website, if you have access to a computer, you can not only watch a long as the presentations are given, but have access to the same powerpoint presentations and background materials that the folks in the room have. there will be a transcript of this briefing that will be available in a couple of days on the alliance website at allhealth.org.

and in this room i want you to know, of course there is a green question card in your packets. you can write a question once we get to the q&a session. and you can also go to one of the microphones that is set up in the room where you can ask the question in your own voice. if you're part of the twitterverse, you can take part using the hashtag @peppertalk i believe this. it is on the title slide you see on the screen. one last note, going to have a very good discussion about the preparedness of the public health system, and they don't want you to think that we are not aware that there is another part of the responsive system that we don't have time to cover with any detail today.

and that is, the preparedness of the health care system your hospitals, nursing homes, other entities, all have a part to play in being able to respond to the kind of disasters that we will be talking about. there's an assistant secretary for preparedness that has responsibility for other programs that are useful in this regard. and we hope to turn our attention to that at some future point. so let us get to the program. we have a terrific panel lined up for you. and then we'l we will turn to yr questions, and we're going to start with dr. georges benjamin dickies executive director of the american public health association which represents our country's public health professionals. he is a board-certified internist. he's run apha for more than a dozen years. and before that he headed marilyn's department of health and mental hygiene so he's somebody who is way with public

health and its role in dealing with different types of disasters at many levels. and were happy to have you back on our panel, dr. benjamin. >> thank you very much for having me here today. i'm going to start by just putting out our new -- >> microphone, please. >> there we go. can you may not? i want to start about talk about a new reality, the fact that we are clearly in a dangerous world where dangers people both with and without state sponsorship, the technology that we have today very, very different than technology we had 20, 30 years ago. with very rapid scientific advancements and lots of people with knowledge of lethal organisms. also point out the nature and we also see the nature is the first terrorist, just because the enormous impact that the nature can have both in creating

infectious diseases as well as extreme weather events. globalization is both a blessing and a curse, the fact that we can have rapid movement of infectiouinfectiou s diseases across borders. we often talk about being one plana right away from being something very bad. we are also one plane ride away from infectious this paper also when playing right away or i should say one e-mail away from communication of very dangerous information that should be out of the hands of people that are very dangerous. we are certainly very, very challenging world today. and as i think you've heard from both our earlier speakers here, about the fact that we still have significant threats around. just remind you that we current have an outbreak which is a foodborne outbreak. without a recent epidemic which shows us a lot about our need to really refine our vaccination

program as well as some of the challenges we've had around infrastructure for public health. the fertilizer explosion tells us a lot about what could happen even in fundamentally rural america, that every part of our community needs to be prepared. and, of course, the annual run of tornadoes that we continue to have through the midwest each and every year that can devastate whole communities. the importance of this is that public health is a central role in all of these things. and, of course, i point out even the boston bombings. what many people don't know, of course, is that the central role of the health department in terms of respond because the health commission oversees the emergency management function in the city and, of course, they were heralded for their fine work in responding to this

emergency. but i remind you that they did good work in a staged event and things were tragically as they should work. button that tells you the importance of preparedness but if you talk to those folks they will tell you that training and preparedness and resources clearly made the difference in their response. i say that because public health needs to have a range of capacities, and these are the capacities of public health needs to have. this is kind of a snapshot of that. we kind of need to know when the new disease enters a community, if we can't prevent. we need to be able to measure it, do surveillance, track what it does, address the health threats. there's a range of capacities that the public health system needs to have. and that's each and every community. not at a selected number, not just our big cities. each and every community needs to have these capabilities.

i also want to point out that he prepared community is one of resilience. so i'm going to use for the sake of discussion today the definition of resilience that we are using a national security strategy. but functionally it basically means, the ability of a community to get back on its feet, be able to respond quickly when you something that happens we have changing conditions. and then recovery is very important. and if you think about the various disasters we've had over the last 10, 15 years, and you think about the capacity of the various communities to recover, that tells you a lot about the internal capacity of communities. all communities have strengths, but communities are different. and i think the goal we have is to make sure that all of our communities have the resilience that's necessary for them to adapt to and recover very quickly from a disaster. we know that too many americans

don't take their individual preparedness seriously. they are underprepared. there have been lots of surveys. this is an example of a survey done last of it basically says that half of individuals, having done some of the simple things that are necessary to be prepared. that's a significant problem that we need to begin to address. and i know the american public health association working with the public to try to address some of these, what we call our get ready campaign to our get ready campaign is a campaign that is designed to build resilience but our goal is to try to make sure that every american can protect themselves, their families and their communities from serious refundable health threats. we've done that by creating a series of resources to try to allow communities to become prepared. we have gotten a very engaged in the social media world, so that we have blogs and e-mails and

twitter activity. we have had events and we have a cat calendar and the dog calendar, all kinds of things to remind people that it's important to get prepared and try to engage them in very, very active ways to try to improve their health, both of the families and other community. i'm going to leave you with one final note, because we're all in this amazing time of trying to ensure that we get universal access to health care for all americans. but i need to point out that even when we achieve a well functioning, health care system of the highest quality that provides that care at an optimal cost, we don't have that yet but we are all working to do that. ..

was not done by the health care delivery system. a lot of this stuff is done by the public health system, and i think when you hear from the other speakers they will talk a lot more about that in greater detail than i can this morning. with that, i thank you and turn back over to you. >> thank you, georges. we are now going to turn to ali khan. dr. khan direct the office of

public health preparedness and response at the centers for disease control and prevention. note that duality of purpose, preparedness and response. dr. khan was a primary force behind the cdc terrorist program and directed its response to the 2001 anthrax at tax, which some of you may recall actually shut down this very building, the senate office building at the time. dr. khan is an internist and pediatrician, and we are very pleased to have you with us today. >> thank you. >> press sit and wait for a moment. don't press it again. now try. technology. in action.

>> good afternoon, everybody. thank you very much for that generous introduction. so, i have a wonderful responsibility and the amazing honor to support the nation's health security efforts. and this is to make sure that americans are save 24/7 from all public health threats no matter what their nature, foreign or domestic, bioterrorism, chemical terrorism, whether they are natural disasters, panamax, a large spills or the public routine threats of everyday that you read in your paper. now, what was very clear, thank you georges from your presentation, while public health defense are very clearly local and state event, there are fiscal and economic ramifications of those events that require national response. and that's why increasingly over the past couple of years we have been talking about public health in the context of ensuring this nation's health security.

our secretary, secretary sebelius, was at the cdc of this weekend during the cost of the conversation with her, she mentioned that we should think of cdc and our public health functions more broadly as part of ensuring our national security altogether. now, as part of our activities -- let's see if this piece of technology works -- >> there we go. >> there you go. not that i need these. i can tell you in one slide what we do. and policy. make sure for national health security make sure we are driving innovation and continuous improvement in our public health programs. we are very fortunate to have about $1.3 billion to help fund those activities, not just at

the cdc, but the state and local health departments. and we also run some critical operations that many of you are likely aware of. the emergency operations center, this is the public health center for the nation, and as we talk with our national and other domestic partners we've learned the strategic national stockpile. this is almost a 4 billion-dollar stock pile of materials we hold and trust for americans for any large public health threat to make sure that we can get life-saving medications and materials to americans when they need them after a public health threat. finally, we also run the regulatory program here in the united states that regulates 300 labs, the most dangerous pathogens in the world. now, the crown jewel of the program without a doubt is our state and local preparedness program. and we put out approximately 600 to $700 million a year still to

our state and local health departments to prepare them for all public health threats. and this is a reflection of the reality of public health. and i think why dr. benjamin preceded me, which is public health doesn't happen at the cdc. public health have been set your state and local level. and that's where the initial detection occurs and the initial response occurs, and we need to make sure that our committees are ready for public health threats and are able to respond to them when they occur. over the past couple of years we have structured this preparedness program around capabilities consistent with the national preparedness goal, and with of this slide i presented for you it shows how we present the 15 capabilities of the state and local level. now, these funds go out not just to the 50 states, a couple of large cities and territories but essentially to 1200 public health departments across the

united states. so, at the end of the day it gets quite diffuse. but you will see from these slides that about one-fifth of the dollars go out for the core epidemiology, disease and investigation, disease monitoring work and the same thing is true for the laboratory activities than the next big chunk for community preparedness. so that's how these dollars are being used in your communities. now what i would like to do is make that a little bit less abstract. i'm missing that slide. i want to make that a little less abstract. i can talk with the capabilities but how does this translate to what's happening in your communities? all you have to do is open up the newspaper to understand what public health is doing in your communities and with these resources are doing in the communities to help with disease, tracking coming emergency operations, communication efforts. sophie outbreak for example but

we are up to 550, 560 odd cases, we are currently activating in response to that and the same set of capabilities help for all sorts of other food or not breaks that you may hear about. today we've released an alert i think it was yesterday we released an alert to all state and local health departments and all clinicians about a solution of calcium that was contaminated with the bacterial product that wasn't sterile. so we've released an alert to get those off the market and ensure the patient or not being infused with this contaminated calcium carbonate. many of you know the story of the fungal meningitis outbreak. 750 cases that occurred. and these were prepared netz -- there's multiple resources the were brought to plead to respond to this topic. but that included preparedness activities to make sure we get epidemiologists who can investigate the outbreak, make sure we have tracking systems, to make sure we have an

emergency operation system to make sure that we have the relationships with law enforcement to potentially track down people who couldn't otherwise track down to tell them excuse me, we would like you to see your clinician to see whether or not you may have been infected with these contaminated steroids. the west nile outbreak we were very fortunate to be able to help our colleagues in texas. i think last year there were about five or 6,000 cases of west nile. about one-third of them actually occurred -- anybody from dallas? no takers. lucky for you. about one-third of the cases occurred in dallas. we were able to use the public health preparedness resources to help them with mosquito spray in the basement efforts. so an example there, same thing you've already heard about the boston marathon and how we in conjunction with our partners in the hospital preparedness program were able to get the community ready for that bombing and other such events. i could go along with c ante and

influenza. but just examples that this isn't abstract. this is what is going on in your communities every day to make sure that you are protected from public health threats. this is to give you a reality of the situation of what happened to the public health funding within your state and local health departments over the last decade. and going off of your comment, i would like to have platinum level hold for all americans if we can arrange that going forward. but you can see there's been a free 40% decline for public health preparedness and response activities within our communities. so, let me end with of these slides. we are always trying to improve our program. there's a couple things we would like to do. one is continue to ensure that we enhance global security efforts. as you heard, pathogens don't need passports.

so they are crossing borders and once upon a time i had a couple of uniformed officers from the public health service. we used to be lucky when the incubation period to get some place was shorter than the time to get here so if you're on a ship coming here to the united states we pretty much knew you had a yellow fever on the ship and we could quarantine the ship. now you can take a plane and be anywhere in ours that is shorter than the addition period of the most devotees diseases in the world saw you walk into the port already infected and ready to go in a new place so we need to think globally about protecting americans. how do we improve our surveillance efforts? how do we improve our disease monitoring activities in the united states and take advantage of a number around the electronic golf gods, looking at other sources of information such as animals? we need to do a better job with that. one of the key things i've noticed in my experience with disaster, so pretty much all of

the disaster as you heard about at the beginning of this presentation i've had some opportunity to participate in them and i've done 20 years of outbreaks over my lifetime and what's become very clear to me is how we get judged as a society during the response is how we respond to the needs of the most vulnerable populations in the communities and we need to get the right so vulnerable populations are communities the need to be -- be the children or people with other disabilities there cannot be annexes to the plan. the have to be integral to think about how we respond and nate vv come meet their needs. how we continue to improve the efficiency of our programs and then finally come an effort that we are heavily involved with with johnson foundation is how do we improve the measurement of preparedness activities with the trust for america and maybe somebody in the audience right there, how are you they put out a yearly report of things they

want to focus on and we are currently working on a national preparedness index, which is a state-by-state effort to look more collectively and comprehensively at public health and health care preparedness activities to think about how we take care of and address the gaps and how we improve those efforts and how do we improve the science of our preparedness. with those priorities i think what i want to leave you with is this. there's a lot of challenges to the preparedness activities and health security ensuring the nation's health security. naturally emerging infectious diseases all i have to do is say age seven, eight and nine and everybody knows by talking about. we are always just at the cusp of another pandemic. i try to be careful to remind people fear is not a public health measure or strategy that knowledge is a public health strategy to recognize how a small disease like sars all of a

sudden can go global given the right circumstances. modified versions of microbes, doing it yourself mix that increasingly likely. devolving terrorist threats from car bombs that come in printer cartridges. terrorists are always rethinking their strategies and we need to always be evolving our strategy is to be ready. obviously the continuing economic crisis and what that has come to public health preparedness funding and then climate disruption of fact and what that can mean for natural disasters in the united states. thank you. >> thank you very much, dr. khan. a comprehensive and very useful picture of what's going on. we are going to turn now to as prats who's the director of emergency preparedness for the louisiana department of health

and hospitals. that puts her smack in the middle of coordinating among federal, state and local agencies that are dealing with and preparing for that disaster this type. she has a rich and various background and health administration roles. she was around during the katrina days and has been around the department more than 20 years. we are really pleased to have you with us today. >> be sure i've got this right. can you hear me? all right. well good afternoon. i think i was one of the last panelists to be picked up on this very distinguished panel. so i thought i would talk to you from what i know in terms of my strength is more in obligations. usually i never had a loss for words. from an operations perspective if you told me, you know, that the problem is katrina, rita,

gustav, ike, the oil spill. they're some of the operation concerns we have. if you said okay how are we going to evacuate have the coast line and a 32 hour period i know who to go to and how long it's going to take. you work with how many hospitals you have in your respective communities and in your state. how many you expect will be evacuated or not, how many can help themselves, how many need the state's assistance and how many of those will need federal assistance. i can tell you. and today, even last night i was talking to some of my colleagues here, too, all of a sudden i find myself not coming up with some words or anxious about what i would say to you as policy makers. and i find that we are asking

for your help to advocate for dollars to be returned because of the things that i know in terms of operations. i can tell you trust from american red cross has a 23 sq. feet per person capacity numbers for buildings. that's slowly been increasing as recommendations are made through groups such as yourself to have special requirements for pediatrics or children that we should have played areas and various things for children so that capacity is now increasing to about 52 square foot per person. what does that mean and operations? that means the number of bills you have before, the capacity is now just lower. so if you could have fit 300 people in the building using the american red cross standards, now you might have to find two buildings to fit the same number of people.

so, the things that you advocate for will definitely have an impact on our operations. so, in terms of issues, from the planning perspective, the grants that we have come of the hpp grant has allowed us to water game with each other and sit in the same room with public health , hospitals so that you can try to figure out what if and your partners behind them in terms of resources from the response perspective we do know the states will be asking for assistance when it comes to the team's and other types of federal assistance to states typically ask for and the

drainings can come to the states to help work and play along side of our states and local partners we ask the hospitals to start up in terms of planning but at the same time the act doesn't allow for the reimbursement when it comes to response. so there are still some issues in terms of disconnect that have to occur. we become crisp and more organized in terms of how we are going to approach the response. but again there are still some things we know we need to address when it comes to health health and medical will get interest immersed so they can help with some of those response efforts. finally in terms of the planted the changing landscape.

we say that the only as good as the last disaster, each disaster is a different monster. the populations are different, the vulnerabilities are different if we can get out bootstraps to everybody perhaps the burden on the state or government, with local, state or federal wouldn't be as demanding but we also have some vulnerable citizens. the definitions from what used to be just ada with the challenge of being blind and being in a wheelchair are now broadening because of all of the grants that we have that you increase the number of local citizens that you have which are lle more of children,

just with a range of grants that we have with most of the grants we will always identify your other types of a vulnerable citizens. the field of sheltering going on and you are trying in that environment to hook them up to various types of social programs so an 18-year-old young lady that might be pregnant i have a social program that she can connect them to but not the same thing for an 18-year-old man. so those are just age differences, formidable differences. the changing landscape with wealthy obamacare issues brann when it comes to response? different insurance payment. i'm sure there might be some vulnerable citizens in that arena as well. and i think if we have some think tanks at the policy level

as to how we can best leverage the dollars. in our own communities i think there would be best for this industry, both public health, the emergency preparedness and response community along with the hpp industry as well. >> and, just so we know what you're talking about, hpp is the health system hospital preparedness program. very good. all right, thanks very much. we are going to turn finally now to jack herrmann who's a senior adviser and chief of public health preparedness at the national association of county and city health officials. he has a background in a mental health aspects of disasters and

is a licensed mental health counselor in new york. so jackie brings some special viewpoint and some special expertise and we are very pleased. i also want to thank the alliance for the invitation to today's briefing. and i would like to start my remarks more from a personal nature. august and september represents a very poignant and bittersweet months and a professional career we will be celebrating, not really celebrating with happiness but celebrating as a milestone the anniversary of 9/11. i vividly remember being deployed that morning to new york city from my home in rochester new york and as i drove and came upon the landscape of new york city i saw the billowing smoke in the air and then entered in lower manhattan and then drove over

the debris from the towers that had collapsed only hours before. and was volunteering as an american across and working with the new york city department of mental health and hygiene to take care of the mental health needs of the families affected by one of the world's most tragic acts of terrorism. a couple years later in 2003, i responded again to new york city. i happened to be there that day for a red cross disaster training when the blackout occurred. in the early hours of the blackout, there was a psychological and next cast over the city because many people felt this might be another act of terrorism. over the course of the night spent time with the red cross staff and volunteers deploying disaster action teams across the city to over 85 years in eight hours.

finally in just a couple of weeks august 29th will mark the eighth anniversary of hurricane katrina, a storm that cost almost 1500 deaths and displaced 1.5 million people. and many of you already know the tragic stories that came out of that devastating disaster. these events and many others that have occurred since then, to use an overplayed phrase it took a village to respond to and a critical member of the village is local health departments. i'm representing the national association of county and city health officials and nonprofit national organizations that is the voice of the nation's 2800 local health departments. we attempt to be a leader, a partner, katulis for the local health department so they can ensure the conditions in their communities to promote health and equity, combat disease and improve the quality and length

of life and protect the overall health of those that live there. a lot of people really don't know what their local health department does. i'm going to switch -- here we go, to a map here. and try to articulate that local health departments are county, city, metropolitan district and tribal government will agencies. the report to the mayors, city councils, said the boards of health or county commissions. some local health departments are units of their state government, some are locally controlled, and others share that authority between the state and local. and as i said earlier, everyday local health departments work to protect and promote health and well-being for all of the people in those local communities. if you look at the demographics of the 2800 local health departments over 60% covered restrictions very small over 50,000 population.

the minority of the health department is about 5% of the local health departments serve the large metropolitan areas but they cover almost half of the nation's population. these are urban centers like l.a., new york, chicago and d.c.. as i tried to emphasize in my earlier remarks all disasters strike locally and the local health departments are a critical part of our communities first response to the disease outbreaks, emergencies and acts of terrorism. over the past year, local public health has engaged in the response to and recover from many major events which some of my co panelists have talked about. both manmade and naturally occurring. hurricane sandy that ravaged the midlantic in the east coast, the boston marathon bombing and the fertilizer plant explosion and west texas are examples of those

and the activities that you see in the slide represent a key devotee the local public health brings to bear the response to those disasters. those are the capabilities that the doctor outlined earlier that are represented in the public of preparedness cable the some national standards. we heard about many of the challenges in response to that event. the experience of their fair of challenges even though we see those as largely successful defense they still were to plunge into the local health departments. the department of health and hygiene had to coordinate a variety of public health services in the hardest-hit areas of the storm hiking up the high rise apartment buildings in the effort to reach out to vulnerable populations making sure they have food, water and life sustaining medications supporting shelters for

displaced persons, and working alongside hospitals that needed to evacuate before or during the storm. in new jersey the health department partnered with their state and federal agencies to provide services to residents and activated the local metal coal reserve corps and other volunteers to take care of the health and welfare of those impacted by the storm. and if you haven't seen the robert wood johnson video highlighting the heroic efforts of the new jersey state and local health departments, go to their web site and take a look. it really is a well done video. many lessons were learned. one of the most important for health departments is the need to ensure coordination with partners ahead of time so that no one or no community goes unassisted. another lesson learned with the importance of understanding the influential role that social media can play in a disaster and all local health departments need to be able to anticipate and meet the expectations of the

people in their communities during a response. the boston marathon bombing in april of this year involved the health department and the medical research corporation coming out in full force. they had spent many months planning to produce a the dennett marathon and were already on the scene of that world renowned event. nearly 200 boston health department personnel were on site overseeing medical activities and trading runners with injuries and health problems in medical tests along the route. when the bombing occurred, they were able to respond within seconds, contributing life-saving measures to those who were injured. and officials in boston decided the trend hospital public health, public safety training and exercises that they had been conducting over the years as critical to this success of that day. finally, in west texas with a fertilizer plant explosion in

this past april which was only a couple days after the bombing, the county public health department worked with the waco emergency management to respond to that event and they also activated their local mrc unit in the aftermath of the disaster and assisted in the coordination of the mental health case management with local mental health authorities. they also describe longstanding partnership between the health to prevent, local hospitals, state level agencies and emergency management with creating the mutual trust that a greatly contributed to the success of that public health response. public health preparedness and response is not just limited to large-scale disasters. local health departments perform critical roles in other health related incidents that occurred over this past year. and as we have talked about some of those this morning, the

fungal meningitis outbreak in october of 2012 where health departments for conducting the contract tracing and the local boots on the ground during the investigations in the 23 states that led back to the source of the outbreak that killed almost 50 people and required scores more to seek life-saving medical treatment. health departments and the impacted state rules are responsible for contacting health care facilities that receive products from the compound in pharmacy to ensure that the utility's stock using the product that potentially could have taken or killed many more. some of you may have heard about the hepatitis outbreak in tulsa. was allegedly resulting from unsanitary conditions and in proper sterilization procedures used in a local dentist office. an investigation screening and the multi jurisdictional testing

can be was executed by tulsa and oklahoma's departments if held. the health department actually had to set up the testing clinics for the 7,000 patients who may have been exposed. and there were over 70 confirmed cases of hepatitis and three hiv cases. though this could have potentially lead to more cases of hiv and hepatitis if it were not for the efforts of the local health department. other infectious disease outbreaks occurred throughout the country this year in sheboygan, wisconsin. there was an outbreak for the local health department to activate their incident command system and conduct a large scale of testing and monitoring outbreak campaign in the sheboygan school system and also worked with the county's purchasing agent to find an apartment to isolate an individual who was diagnosed with multi drug-resistant tuberculosis. previous and current investments and preparedness largely

contributed to the county public health department being ready to handle the ball break. training and exercising along with the health department's partners helped them better understand the role and follow the principles in those partnerships also help them work together seamlessly to amplify the key public health messages that had to go out around this incident to the public. many of you have heard about the outbreak across the country that's affected 19 states and resulted in almost 550 cases to date and the hospitalization of 34 individuals. there were also responsible for helping to trace and identify the source of the parasite back to the prepackaged salad mix and

the local health departments continue to conduct investigations and interviews today with suspected patients. so that take away of these events is that preparedness is not a static process. vignette a process that requires ongoing planning, training and exercises and the sustainment of the capabilities to protect the nation's health and welfare. preparedness happens before and even occurs, not during. the fire department doesn't sit back and wait for a fire and then decide to go out and buy a fire truck to respond to the fire. when you think about it though, that is exactly what we do during a disaster. think back to the big federal funds that went out the door after 9/11, hurricane katrina, h1 in one, and then most recently superstore sandy putative investment in public health prepared mess need to be made in advance if we respect any -- i expect a successful

response. the preparedness of the local health departments today that they use to respond exist because of that investment of dollars, the investment of time and resources personnel provided at all levels of the government, local, state, federal as well as those from the non-profit and private sectors. however it is critical health program including those in preparedness or cuts. the ability to sustain the key devotees and capacities for local health departments response diminishes. let's look a little bit at what the health department supports their public health missions including public health preparedness. this chart illustrates the funding sources for local health departments. and you can see that federal funding makes up about 20% of the health department's overall budget. the remainder is coming from the fee-for-service, state and local tax assessment or other funding mechanisms. however, almost 60% of local

health departments rely exclusively on federal funding to support their preparedness activities. four of the nation's largest cities receive direct federal funding for public health prepared mess through the cdc preparedness grant program and the hospital preparedness program. while the rest of the local health departments rely on an allocation of these grants passed through the state health department. it's also in part to the point out that fema is separate from the previously mentioned programs, but it's not duplicative. this program ensures that the first responder agencies, police, fire have the resources they need to respond to the disasters large and small so the take away message here is when any federal grant program is cut khayat has significant and sometimes dangerous impact on the programs that rely on. the survey conducted in the latter part of 2011 found that

almost 60% of health department's cut or eliminated one public health program area as a result of federal funding cuts in that same year almost a quarter of the local health departments had to reduce or eliminate the prepare best programs because of these funding cuts. since 2008 we have lost almost 44,000 jobs in the local public health work force, and that those jobs represent real activities in local health departments they are there to prepare for disaster, respond to disaster and will be used in the yvette that community needed to distribute and dispense lifesaving medical

countermeasures in the aftermath of the disaster. the cuts that have been seen in public health emergency preparedness funding. the hospital preparedness grant, the hospital prepared must grant proposed 114 million-dollar cuts in fiscal year 14. those funds largely support public health departments, hospitals and health care coalitions to prepare and plan for disasters. just to draw your attention today these cuts have created significant impact on the local health departments as i have been mentioning and this slide talks about health department in wisconsin and kentucky and frederick county maryland who have had to shoulder their

immunization clinics or lay off staff who largely would be the people they would rely on to either prepare or create their plans for the disasters or actually respond to disasters. so finally our takeaway and recommendations undoubtedly the system is more secure than the events of september 11th and the texas have supported critical public health preparedness programs. we build a strong and vibrant national preparedness capability that begins and ends the local level and we need to sustain those investments. the local public health community acknowledges the need for science based measures to improve the capabilities and show the return on investment to congress and the people. and some can say that the response to some of the defense i talked about this witness to return on such investment.

and we have to remember that the state of preparedness is not an end state. it is a process. every preparedness funding has tangible consequences for your constituents and the communities you serve. the support of training and exercising through the public health grants i mentioned keep communities agile for the response and resilient to the recovery. investment provides the staff and service necessary to support long-term recovery. and the continued support and investment in the development of the critical public of capabilities and capacity at the local, state, regional levels ultimately builds a nation prepared and protected. >> thank you very much, jack. let me ask one question to clarify something. if you get back to jack's slide on the job losses over time, your note talked about 4300 jobs being lost.

they are being created so that there was a small net loss. it represents real people in positions that were identified in public health to provide public health services and health departments coming and even though the figure for 2012 may look promising and bright that doesn't account for the impact sequestration that we will have on those jobs and positions in the health department's. >> now we get to the point you can join the dialogue if you would like. as i mentioned, there are microphones to which you can come and ask a question in person in which case we would ask you to identify yourself and

keep the question as brief as you possibly can. you can write the question now if you hold it up someone from the staff will snatch it from your fingers and bring it forward. i would also encourage the members of the panel and the doctor co moderator to join at any point of this dialogue that you feel the need to. you have the first question in the sequence. >> in recent months have there been any changes and additions to the partnerships taking place with volunteers, particularly those affiliated with religious communities >> with other organizations in the community has long been the

practice and local health departments. they recognize they can't do it alone. and so for many years there have been efforts and attempts to link with a variety of partners including the feith based organizations. and so, as you look across the country they are reaching into those organizations to populate the medical reserve corps, the red cross team coming disaster mental health team. so i would say that it is common practice to reach into the organizations to ensure they, are there. those communities are there to help out during a disaster. >> are they replacing any of the lost jobs? there is a possession and health departments, staff positions in health department that just because of the h.r. law they

can't use volunteers but speaking with health departments because of the attrition that the have seen over these years they have had to reserve duty to rely on the medical research corporation and other assets in their community to conduct preparedness outreach campaigns to go out and do staff health affairs and things like that on behalf of the health department. >> to put this into a little bit of a perspective, one of the things that has impressed me at the disaster sites that i've seen is the role of the volunteers. the american red cross for instance is one organization that is slated by congress to be actively participating in disasters. but when i went on to some of the relief efforts it was the southern baptists serving the meals and they do that all up and down the east coast and the west coast and in the recovery period they have an incredible system of helping people put

their homes back together. one of the stuff that came to the foundation had a health department in new hampshire and they lead off the staff who were involved in doing contact tracing for diseases, sexually transmitted diseases which would include hiv. so if the outbreak that had happened in texas had occurred in a hampshire that isn't something volunteers can do. it takes training and public health. what happens is when those individuals get laid off, and this happens to me in my agency when i was back in illinois they get hired by the private sector. and if those jobs are then created again it's very difficult for the public health agencies to hire people with those kinds of skills, those public health skills which are very hard to hire so it does create a lasting deficit and the ability of the public health

system to respond. >> i have a question for dr. khan. you mentioned the preparedness index the cdc was putting together and i wondered if you could elaborate what purpose that is going to serve and when it is going to be available, what elements are going to be included. >> the doctor serves on the index. so let me start and then handed over to john. this is a state-by-state comprehensive index of preparedness but over 150 of measures and health care and public health that are publicly available. at the index the process is designed to draw preparedness in the communities and provide objective evidence and concrete

beams, actionable things the community can do to improve their preparedness and then to drive the science. we are very big on accountability and we need to measure preparedness in the communities. we've gotten a lot better over the last couple of years and we want to continue to improve those measures of preparedness. this is an effort that is being shepherded by the territorial health department's. and dr. lumpkin as i said serves as the chair of the government's group. since this is many partners coming together and doing this it is and the cdc alone. >> let me also say that one of the reasons why this index, and it was a process that has been initiated by the centers for disease control and prevention as well as the association for the state and territorial officials and our foundation is happy to have an opportunity to participate in that process.

the preparedness is part of the charge also. but it's really challenging to figure out where are you going to spend your next dollar if you're going to increase preparedness. the increased preparedness and if you are trying to do work how do you do quality work within preparedness and so this index is designed to be initiated by the cdc but not part of the process of reviewing the grants and that is a critical component. it's not to review how well the state is doing on the cbc or the grant from the office of the assistant secretary for preparedness response. it is a tool for the states to use working with local communities and local health departments to assess the level of preparedness and to assess quality improvement.

the first numbers will be coming out in october and will not be designed to rank or compare states. again it's going to deal to help the measure and an initial one and then over time help the work on preparedness is progressing. >> my question is for ms. prats. i'm a reporter with ceq. you touched on the issues with the stafford act. can you just elaborate a lot more particularly on the issue of reimbursement. the stafford act is whenever there is a natural disaster you have a stafford act cake and which pretty much the rules for what gets reimbursed and what does not get reimbursed. so usually you have that reimbursement flow versus the on stafford act issues which are more of.

bp has to make it whole. so you will see the company that would pay for the damages. they're usually has to be a funding streams and then you can get various things reimbursed. >> was that an issue with her working katrina at all? >> the reimbursement? yes, ma'am. >> thank you. >> there are some things and it's worth looking at the stafford act. it says the federal government only pays for bringing whether it is a hospital or a community back to where it was before the incident occurred. and that is understandable because if you have a house and you have a 20-year-old furnace, you don't want the act to be replaced in the furnace and the windows and of the roof if they are not damaged.

one of the peculiarities if you will remember from super storm sandy the hospital closed down in manhattan and it closed down because when the storm came they had moved their generators up but they kept the fuel on the lower floor because of was a little bit safer. when the water flooded they've recognized, the sensors recognized it as being a fuel spill and it cut off the generators and they lost power. so the generators were operating now they are going to rebuild that. they would rebuild the hospital to move to become moved from the basement at the higher floors. some of the provisions sometimes it is very hard set and was very

clear to understand sometimes there are intended consequences. >> dr. lumpkin is very right. those are the subtleties when it comes to patient care. if he wore a hospital and you uxor all these people that started to evacuate so they don't meet the criteria and if they met the criteria then they get medicare and medicaid, third-party reimbursement. but anything else. so if you were sheltering from the hospital couldn't claim any of the costs through the stafford act and in fact there is no other means for them to claim any of those sheltering costs. i'm not sure they have that money. we have reports anecdotal at this point no full study it hospitals would continue to shelter and surge, we know the operational costs go up at least

50%. so if you have a neurosurgeon today, you can pay him during normal business but during the storm the are going to start decompressing their facilities, they might start helping with the sheltering operation. but the hospital still has to pay those operating costs. and there is no where to claim some of those costs. so if you take it from a store environment that's like three to five days you might lose some funds but what happens if you have a pandemic flu? if you are out for months, five weeks or months, what happens to those types of costs? i'm not sure that there is a solution for the public health issues that might come up related to the surging. >> go ahead. >> i am with the senate

committee on small business and entrepreneurship, and my question is particularly to mr. herrmann that either of the panelists and it is what kind of preparedness techniques or prepared best are you getting ready for when it comes to small business because as we know a lot of times people are at work when these disasters occur. so what's happening in terms of keeping employees safe or even safe from an actual disaster if something were to occur at the work place? >> that is a great question. and the quick answer is not enough. but with the local health departments are doing is finding ways to partner with business small and large to help them understand how to develop the continuity of operations plan so that in the face of disaster they will be able to take care of their employees and be able

to carry out business, which is important to the economy of those communities and you raise issues like what would happen in a disaster like say the flu pandemic where many of these individuals may have to be out of work because they are sick or taking care of sick family members and that business has to be shot down. in the communities all business is vital so those are the type of issues they bring to the table with businesses to help them kind of work through how is your business and how large your employees prepared to handle a disaster if it strikes them. >> dr. khan? >> that is a thoughtful question. over 40% of small businesses are closed after a disaster. so clearly this is an impact on small business. you've heard about the efforts the local and state health department and other efforts

with the critical infrastructure work to help the business think about the continuity of operations. and it's always important i try to mention in this fema the supply chains and other elements if we can try to understand what's going on in the communities and outbreaks the will the information available to understand what is the impact on the business. we've spent months in singapore helping them to respond to the of greed and some of you may know the large airlines almost went out of business because nobody wanted to go to southeast asia anymore. so there are global impacts of these outbreaks and significant economic impact. >> let me add one other thing. >> to think of small community providers and small business, as we are very much concerned about hospitals but the truth of the

matter is while they are a challenge, any time these disasters occur, the small community-based providers have all the same challenges. they lose infrastructure. it's really in the outpatient setting, not the hospitals. so that is a big capacity that we lose and that is true of people in vulnerable populations, substance abuse, mental health providers and primary care providers. >> we have a question that relates to the supply chain as dr. khan was talking about what it does get us back to hospitals. give us your thoughts the questioner asks on the vulnerability is the hospitals have been relying on offsite providers of services such as land in santa gallons and waste disposals to keep the hospital

running on the pandemic to be this bill if it is a problem, what in the world could you do about it? >> it is a planning issue for communities. one of the things we were doing right before 9/11 is looking at that question of the supply chain in the state of maryland. what we discovered was every hospital had a wonderful plan and they all rely on the same provider. so what happened is in many communities the planners are looking at that and they are challenging supply chain to make sure that they are both backup suppliers so the redundancy working with hospitals and hospital associations and they

are very much aware of that as an issue that continues to be resolved. >> that really ties into a commented jack and the other speakers made which is that preparedness is not a destination. it is a journey. every time you do a disaster or drill and work through that, you begin to ask questions and solve problems. and then when you go again, you find other problems. the first disaster drill i ever worked for is when i was at the university of chicago and we will schedule the duralast 9:00 and we are sitting down in the er and 9:00 came and went and 9:15 came and went and finally 9:30 the operator gave a call to tell us that there was a mac drill. they were given a call list and the emergency department was all the way down at the bottom. you wouldn't have known that

until you have gone to the drill or had gone through a disaster. .. it really describes the importance of ongoing preparedness. >> i couldn't agree more and i think that question gets to the heart of this. you get to preparedness and isolation thought, always reminded during certain

responses when nursing homes plan to evacuate each other. because they hadn't spoken to each other, and so they send patients to each other and that was their response plan. i think that talks to the wonderful work being done by the hospital preparedness program, it talks about the work done by your local state health departments, talks about kenya be prepared to get to integrate your plans and looked cohesively of wha which were doing. and i also want to remind you all, you individually have a role to play to protect yourself, your family and your community. >> go back to your slide showing that half the folks who are serving didn't have that kind of plan. it gives you some sort of mentioned that part of the problem. >> minus danielle. unrepresented organization called amplify. piggyback off this idea prepared to my question which to the data and receiving data when networks go down in disaster.

i'm kind of talking about the lockbox issue. a lot of the exchange of data is relied upon broadband or towers that may be affected and i was respecting efforts to go about that, the issues that arise from it. >> let me start by saying, it would be nice to even have that problem. because our biggest problem is still the lack of having all the information in a data system anywhere. and building a robust electronic medical records system. but when you do build that you do have to build a redundancy you talked about. i think that's very important. there's not a proof of concept here. after katrina, it was very clear

that those systems that electronic medical records, that the ability to reconstruct patient's medication lists and medical problems and things were enhanced. we did see that, again, lesson learned from katrina. fast-forward to superstorm sandy, those hospitals in new york that they can have a robust system and, of course, new york city's of course new york city's health departments but it was a fairly robust medical record system. they were also able to very rapidly reconstruct that information. but it does rely on not just having the information in one place but having a robust, hardened back up system and maybe to, for the data, and the capacity to rapidly reintegrate the networks when they have those disasters. >> anybody else? yes, go ahead. >> thank you. i'm with an organization called the secure id coalition.

when we talk to electronic health records and having data on a second benefit web, when and how people are treated in emergency situation. i'm reminded of a story. i was in san antonio -- san antonio, texas, last year, there were smartcard some people which hasn't information on them like allergic to penicillin, diabetic which a lesser better treatment. there's one group that had the first group i think was normal populations like we would be now without any information. the second population of the cards that had the information on them, you know, secure readers, encrypted, all that. i wish is when if you guys had heard about that and what do we do you think about something like that? >> i participate in the exercise on very family with the. you know, a couple things. anything we can do to better

prepare the public to tell us, public health and health care, what kinds of medical conditions they have, what kind of medications they have, other kinds of illnesses that ultimate are going to make them vulnerable in the aftermath of disaster is an important thing to have come or it's important information to the. but it's not the only thing. it's not a panacea. frechette to get people to remember to take the card with them when they run out of the house. then you have to make sure that the sites they're going to show up in and have the ability to read that card. then the third thing is you have to have the staff to know how to interpret the data and understand that david so that they can protect the patient's health. but it is an important mechanism. it could be an important mechanism in saving lives and ensure that people get the right help when they need it. >> jack, was there any resistance to that initiative on the basis of privacy concerns a?

>> interesting, the ama did a series of surveys and public engagement, and that, while it was an issue that was raised, it wasn't one that was enough to say we can't look at this as an option. clearly, people will always be concerned about where their private information is going. and as we've experienced over the last number of months with releases of information, people wonder how much access the government has come information on them, it will always be a concern. but the overarching message is we need to look at what's in the best interest of the people. and in this case, we know that many people come to shelters during a storm, having a number of medical illnesses. many of them only know, well, i take a white bill before go to bed. i take a purple pill in the morning. they don't know the name and the dosage of their medication. and so anything that the public health and health care community

can have access to to help them better treat that individual i think is warranted. >> we've got a question that maybe rosanne can take initial crack at. in past disasters, many people would not evacuate when told they could not bring their pets. what steps are being taken to ensure the safety of animals in future disasters? what do you do about dogs in louisiana? >> welcome i think if i die i want to come back as a pet because you would have a lot of stuff that, you, you would be provided and you would be well taken care of. but that is true. in katrina their instances of people who become very attached to the pets and you even get separated if they could not bring their pet within. so we doesn't very robust plans when it comes to enabling an evacuation both with coach buses and along with the coach buses

there are other types of places we can put the pe patch on those vehicles, usually tagging along a high in the coach bus. so people at different types of pets that you're not always easy, small little dog. they can be large animals, and of course people have vulnerable issues don't want to have the pets on the bus within. so you get into all kinds of operational logistical details when you're trying to organize an evacuation. and, of course, the point the big dogs that you got, snakes and some people put the snakes in, you know, what -- just a bag. call it a cajun suitcase, you, your plastic bag. [laughter] something comes crawling out and you might have, people would have gerbils and it's not -- so yes, we have cages, pet cages your we have the veteran marion

-- veteran and community and the volunteer community that is truly become very engaged with trying to assist with this type of evacuation. so we've got not only general shelters, but we have pet shelters along with it and it ty will have people that can go visit their pets to help take care of their pet. because they know what their pet likes to do or not likes to do, and they come down as well. and while i have your attention from the larger evacuation is not only the human evacuation but is the evacuation of cattle. so you would not expect that in talking to health and medical, but planning alongside your partners, i didn't realize this but you can get into the eyes of cattle -- did you know that? so i guess it got me something today. so you have an evacuation and we

need, we have e-mac. we have the e-mac cowboys and their horses that come down and help with an evacuation of cattle. so it's all kinds of evacuation lanes that go on between human movement, pet movement, cattle movement, hospital movement, nursing a movement, and the state is right in the middle of your local communities and all these needs. and they're just sometimes overwhelm. so again we are advocating that we can get these grant dollars with planning. >> jack, what about the snakes? >> i have seen many a stake in my travels. we chuckle about this, but really pet prepared as is very, very serious. in fact, the reluctance of people to leave their pet does create threats to injury and death.

and so health departments as part of their planning criteria had to talk about what they are doing, to working with the community in order to prepare for how individuals might evacuate their pets or what kind of plans to have anything of disasters in their community. organizations like the american red cross are working with national and local organizations, veterinarians, to increase health preparedness and medical reserve corps. even are looking for veterinarians and other animal specialists to work alongside other health care professionals to be able to respond to pet needs during disasters. >> does anyone else want to throw in a pet comment? okay. several questions that people have submitted by guard that would like to get our panels response to. as we have seen this person

writes over the past several years, climatological disasters, natural ones can have been a great more frequently and with greater severity, often leading to infectious disease outbreaks and/or technological catastrophes. what steps, if any, are cbc and nato taking to address the ramifications of climate change? specifically at the state and local level, which i guess means, rosanne, if you want to chime in on that we would like to do that. or georges as well. >> i guess from -- we have approximately 30 straight -- state declared disasters the year. usually that means the state starts to lean forward and notify all the local basra recall parish departments to start being ready, weather, to respond to whether that's flooding, tornadoes, et cetera. so what are we doing? we have a lot of frequent, we

called we are the live labs. it's no longer just trying to plan. we are actively engaged. we're trying to be in response. we do eat up a lot of funding for that, so i guess that's just another plug for yes, we are saying that natural, that increase of disasters, and that is requiring the state and the locals to start ramping up at least 30 times a year. >> how about national in? >> -- national in? >> so, the american public health association has been working very diligently just about 99 with cdc naccho to do -- personal, bring awareness to public health practitioners. number two, to try to strengthen their skills and helping build

capacity in their communities. we did two things. number one, adoption, fanfare how to adapt their communities, and to be involved in the mitigation aspects of the. so what does all that mean? number one, you know, one of the challenges we have with all these very severe climate events is, one can rebuilding in the same places, not changing the way we are building, not putting up seawalls when they need to be up. one of the lessons learned i think from katrina that we so or heard john talk about in new york was hospitals are now moving her generator from the basements is where we used to put them and putting them in other places, putting them on higher floors. but you do learn new lessons want to do that, and john talked about the fuel lesson. but we have a lot of older cities and a lot of the older cities still have wires in the air. and those are very vulnerable to

trees falling on them and disrupting power lines. i think getting public health of the table so they are a part of the discussion, so we are often speaking about the public health being now and able for hurricanes and tornadoes, but also think that extreme weather events, things that are too cold, seeing a lot of extreme weather events when things are getting lots of snow and ice, et cetera in places that were not designed to get snow and ice. the housing isn't built for very cold weather. the same thing is happening in places that are getting very hot weather for prolonged period of time. so those places are much more at risk for heat related injuries. group you know, prolonged heat, high humidity for three or four days. so building those plans so that you can address, educating community can making sure you

have water to drink, identify where foldable populations are so that when the power goes out you can get to those people and get them plugged in to someplace that's either cool or or where they can get their medical needs met, or their depend on electronic equipment for medical equipment for these kind of things, giving them there. all those are the kinds of things that have to have have a very strong public health role in doing that. but as jack said, most of this happens at the committee level at the local community level. and requires people, training, skills and expertise to make that happen. >> we have time for just a few more questions. one, from a congressional staffer asks what's been done to ensure that populations with language barriers are aware of the services that are available turning a disaster.

jack? >> this is also, we talk about all the important issues that go into disaster preparedness, and certainly this is one of those that ranks right up there. winning individual is here and their primary language is not english, it presents a vulnerability for them. especially in a predominantly english-speaking society where there may not be services to translate those important education materials and other information into different languages that those individuals speak in those communities. let me call out -- has done an amazing job with this. they found a way to work with partners to translate many other disaster preparedness material into multiple languages that reflect their communities. but they first needed to go out

and find out what length which is people spoke in those communities. and work with the leaders of those communities whether they were religious or otherwise, to help translate those materials and educate those communities about what they needed to do during times of disaster. what services would be available to them, and how they could take care of themselves and protect their family members. >> let me add they get ready campaign we have that apha. with fact sheets and about 50 link which. so get ready campaign is a much designed for the community, individual and the community to get ready. we are working hard to get everything we have in multiple languages. i can't say that everything is but i don't think with everything in 50 languages, but we have different -- 50 different leverages for the very fact sheets that we have. >> let me just ask as we are dealing with these last questions that you fill out that

green -- blue? so we can respond to your wishes and your needs in future programs your for the panel, the questioner asks that you speak to social media and a state of local health departments are using social media for preparedness and response. >> jack, your our leadoff hitter. >> social media and is, has just exploded on the disaster preparedness front. and i think, i had wanted a fortune opportunities to be in the red cross national headquarters disaster operational center during hurricane stand him and part of my job was to work on monitoring social media and better understand what were the public

health and mental health challenges that individuals were experiencing, and writing over social media technology. and we were flooded with thousands upon thousands, millions upon millions of tweets and face the posts and other things, people talk about the disaster and the experiences they were going to at the time. and it was a lesson that somehow we have to do better at being able to monitor social media and quickly respond to the needs and expectations of those individuals and communities. it creates quite a demand on public health in an effort to better understand how the kennedy is using social media technology -- how the community is using social media technology, and more important, an outlet for situational awareness as to what's happening in those communities during times of disaster. >> and i can tell you that

nationally at apha, our twitter account of we have a quarter of many people on our social media activity, and so the twitter account for apha is packed, get ready. something happens we are always putting out information, so that people can begin having a conversation and get information about the event. >> similarly at the cdc with embrace social media for different purposes but classically can people think of it as a way to share information. we have the third largest government weaker -- 20. it's also way to listen to her communities. we do monitor social media aggressively and we're about to put out a project that will be available to archimedes called project dragon far as we to understand what is going on in their community very quickly and take action based on the link to the federal agencies. it's a wonderful way to get target information out to our communities.

>> i think we're at the point where i would like to call on dr. lumpkin foreclosing remark or two. >> great. well, thank you again to the panel for coming and to all of you for listening, and asking really probing and important questions. i think perhaps the most critical take away is that if you think about being in a place where you have state or local government is going to be responsible for helping your 20 recover from a disaster. you don't want those individuals to be exchanging business cards at the sight of the disaster. you want to know that they've been talking to each other. but you've also heard it's equally as important for people to know and to think about this because the time to think about the disaster is not when the hurricane is bearing down on your house but you want to think about these figures before that. all of that means that these

mechanisms need to be in place. they need to be tested. and people need to be reminded. many years ago when i was back in unites its government, running a nuclear power plants we handed out pills or iodine because there's a disaster, people should take iodine to protect the thyroid. how many of those people know where those pills are today? this process of ongoing preparedness of making the system, reminding people is what will enable us to have the best out, so that the people of this country can not only survive but survive in a way that will enable them to quickly recover and return back to their normal ways of life. >> great, thank you much, john. let me just say, a, don't forget about the evaluations. b, i want to call attention to erin began on our staff who is

finishing up an internship at george washington university and he did the bulk of the work on this briefing as an exercise that was both academic and real world. thank you very much. and something that -- yes, absolutely applaud the. >> and something that john lumpkin can do and that is to think the robert wood foundation for the shaving and the cosponsorship of this briefing. and let me reiterate john's thanks to the panelists and ask you to help us thank them for an extremely useful and great discussion on every tough topic. [applause] >> a couple of programs coming up later today.

robert draper wrote a national geographic magazine cover story about moammar gadhafi 42 year rule of libya and the future of the country as a democracy and has joined us on "washington journal" and you can see that conversation today beginning at 7:05 p.m. eastern. booktv in primetime continues tonight with author and columnist melanie phillips, the author of nine books including her latest guardian angel, a memoir for personal and professional life as a journalist in the uk. you can see the interview from our in depth series at 8 p.m. eastern here on c-span2. later today minnesota senator amy klobuchar speaks to north iowa democrats and clearly. she is the keynote speaker at a fundraiser, and according to the "des moines register" she is the first democratic hopeful to visit iowa for a possible 2016 presidential campaign. more about that now from jennifer jacobs of the "des moines register." >> we will be covering the amy klobuchar event in clear lake,

iowa, was called the wingding. tell us about this event. she speaking but she is honoring hillary clinton. how is that going to work? >> right. so they are getting an award hillary clinton at the calving sm county democrats up north in the mason city a. they get together and each year they give an award to a democrat. and amy klobuchar is this year coming simply to help for bruce braley who is running for the senate. she's also spoken to some i was at the national convention. our activists have seen a couple times so she says is meant to work for bruce braley spent does amy klobuchar are have an interest or is there talk about her possibly form some sort of interest in running for president in 2016 speak was yes. when we asked her in north carolina she brushed off our questions about running for president but we had some

activists who were here last week and they're promoting a generic male candidate for president and amy klobuchar was one of the names that the president of emily's list name dropped. if you look at pretty much any hot list of possible democratic candidates that hillary clinton is not run, amy klobuchar ourselves always on that list. >> just remind you ca can see or road to the white house 26 in coverage from clear lake, senator klobuchar's comments, our coverage getting underway at 7 p.m. eastern on c-span, also on c-span radio and online at c-span.org. >> tonight on c-span's encore presentation of first ladies -- >> she was very proud of her husband, no question, she support all of his decisions but once again she was a very private person. so it was fine for husband to be in politics, my friend for the washington and be in a senate committee and congress come but she didn't want to be part of it. and yet she causally supported

his decision to do that all of the time and she was very much supported during his impeachment i know there were other things that were attributed to her that she wished that she could be back on where they belong and things of that nature but she honestly believed that her husband would be acquitted and was ripped out of it when he was but she kept saying she knew that what happened or chaplain the. spent the encore presentation of our original series continues tonight at nine eastern on c-span. >> defense secretary chuck hagel released a statement yesterday outlining new efforts to prevent and respond to sexual assault in the military. pentagon officials briefed reporters on the new initiative saying the sector plan still weekly meetings on the subject. george little also comments on the president's decision yesterday to cancel a planned joint military exercise with egypt in response to the violence in that country.

>> a limiting sexual assault from united states armed forces continues to be one of the department of defense's top priorities. every service member and dod civilian deserve a safe environment in which they are free from his threat of sexual harassment and assault. secretary hagel will continue in iowa and approve prevention and response programs. in may, secretary hagel directed a range of measures designed to strengthen our program in the areas of demand accountability, command climate, victim advocacy, and safety. today, the secretary directed the implementation of the following additional measures to improve victim support, strengthened pretrial investigations, enhance oversight, and make prevention and response efforts more consistent across the military services. first, creating legal advocacy programs in each militants with the provided legal representation to sexual assault victims throughout the judicial process. next, ensuring that all pretrial

investigative hearings are conducted -- [inaudible]. third, providing commands with option to re-sign or transfer service members accused of sexual assault or related offenses in order to eliminate continued contact while respecting the rights of those victims and the accused. requiring that the first journal officer with enchantment receive timely follow-up reports on incidents and responses. directing dod's inspector general to regulate evaluate close of sexual assault investigations. standardizing prohibition on inappropriate behavior between recruiters and trainers and their recruits and trainees across dod. and, finally, developing and proposing changes to the manual for courts-martial when victims give input during sentencing phase for courts-martial. all of these measures will

provide victims with additional rights, protections and legal support, and help ensure that social related investigations and judicial proceedings are conducted thoroughly and professionally. the department of defense has also established an independent panel in accordance with the national defense authorization act for fiscal year 2013, ma and this penetrating and assessing their views do investigate and prosecute and adjudicate crimes involving sexual assault and related offenses under the uniform code of military justice. secretary hagel has met with panel members and he will closely review their recommendations when complete. sexual assault is a stain on the honor of our men and women who serve our country, as well as a threat to the discipline and the cohesion of our force your it must be stamped out. secretary hagel will continue to meet weekly with duties senior leadership team to personally review dod's efforts and ensure

that directors and programs are being implemented effectively and the department will continue to work closely with both congress and the white house on a limiting sexual assault in the united states military. we are all accountable to fix this problem and we will fix it together. >> a reminder can you can see that briefing anytime online at c-span.org but also send at about 2:45 p.m. eastern on c-span. next, key members of the supreme court case discuss the future of marriage in america, lgbt rights and the effects of the supreme court decision to strike down the defense of marriage act and proposition eight in california for this discussion took place in july figures martyred by the yolanda jackson of the bar association of san francisco. is an hour and 15 minutes. >> so, good evening everybody.

i can't tell you how excited i am to be at a podium again with a group of such illustrious trailblazers of this area. i have a great opportunity to do this several months ago before the decision came down. matt was on that panel with us, and they never disappoint. they have so many nuggets of information to share her to walk away scratching your head ready to cry a little bit, ready to smile a little bit and you here tonight that even with the great decisions there's still a lot of work to be done and i want to spell to really help you all sort that out, all sort that i forget what are the next steps, what does this mean to us nationally -- i cannot talk tonight. that's not a good day for the static nationally for marriage in america. i would like to really take a quick moment to introduce the leader of the bar association of

san francisco, dan burkart, who is here, and a president bashir, our 100th president, chris carney. so please join me -- [applause] >> okay, and a brief introduction of our esteemed panel this evening. to my far right is angry came in august and he is the attorney for sandra. and he is an attorney with the law firm of gibson, dunn and crutcher. to his left is kristin perry, and she is one of the plaintiffs in the hollinghurst versus perry case. they we have sandra who is a plaintiff in the hollinghurst ursus perry case. next to her is matt was the deputy national legal director of the aclu. and last but not least, christopher stoll was the senior staff attorney for the national

center for lesbian rights. again, let's welcome our panel. [applause] >> so, matt, have you had a chance to catch her breath? >> i have. >> we are starting with you. can you give us a brief overview of what was decide exactly into property cases? and did the supreme court get it right in the decision, in your opinion? >> well, the supreme court, the edge the last question is always yes. let me say to framing things. one is that are really two sets of marriage cases in the supreme court last week reversed the way to case and the case of the poor in the united states report, and any by john robert on one and kennedy on the of the there's the winter day days and the very case that were reported in the new york times, cbs news and across the blogosphere and i think they are very different cases. i think those political cases where enormous victories but i think the legal cases were

somewhat more modest victory but it's important for the public and lawyers not to confuse the two, something that i'm sure we will return to. the property case i think probably needs no introduction at we all remember prop eight. the california supreme court in may of 2008 decide that it was a violation of the state constitution not to allow same-sex couples to marry. opponents had qualified a proposition, buy the most expensive noncorporate proposition ever to go before the voters. they cost about $84 million. and we lost 52-40. there were state court challenges that failed and this was the famous federal court challenge claiming that prop eight violent the federal constitution famously brought by ken olson and david boyd. claiming that prop eight was invalid under the federal constitution. that was the greece was originally presented was good

the states under the federal constitution good income prohibit same-sex couples to marry? was committee will, framed original as a 50 state case. the case has a surprise in it, almost from the start which is a state of california watch and under eckstein governor, arnold switch axes, is a constitutional? i don't know. why don't you tell me. and the attorney general goes in the behalf of the state and says, well, we're not going to issue these marriage licenses but it is unconstitutional to in 1996, congress passes the so-called junta called so-called defense of marriage act. it's fast as i think i will readily admit to be used as a device against william clinton the upcoming presidential election when he vetoes it. and the defense of marriage act says when you put it together with the rest of the federal code, we come the federal

government really don't care very much about the definition of marriage. we an entirely leave it to your state but sometimes a state that performs the national sometimes the state you live we don't have any definition of marriage. and less your state recognizes the marriage of a same-sex couple in which case we won't recognize it under any circumstances for any purpose under federal law whatsoever. a remarkable thing. nothing like that ever quite passed before. the case comes up when he went to live with her partner for 41 years had been married for the last three i think our partner died. she is executive of her estate. she is compelled to pay 350,000-dollar federal estate tax because the federal government under doma treats them as unmarried, even their own state treats them as many. discriminate against same-sex couples by the federal government under doma and

constitution. and there's another surprise, not unlike the surprise in the perry case which is the federal government comes in and it says we're not going to give her the check so we are enforcing the defense of marriage act. right, we think she's right action. it's unconstitutional. it violates the federal constitution. so you have to cases posing a very similar question. can you deny same-sex couples attributed to opposite sex couples in marriage and in both cases the government is coming and saying we will law but actually we think the laws unconstitutional. it changes when the governor in california refuses to appeal the case. and the government in the winter case keeps appealing it and keeps it alive. so the cases arrived at the supreme court with two questions in each of them but one question, does it deny equal treatment under the federal constitution to treat same-sex couples differently? the second question or is there still a fight? is there anyone with a live dog

in the fight? and hear something how they come out. in the prop eight case the courses there isn't anybody with a live dog in the fight anymore. and people are trying to fend this case wouldn't be bound by the order they would have to pay attorneys fees if they lost the they wouldn't have to pay court costs if they don't have a stake in the case. the cases over. it ended in district court when the attorney general failed to file an appeal. it is one of the most constitution was would call a real but terribly uninteresting article iii of the federal constitution, a case about standing or whether there's a real case. in windsor they look over and they say at least there was a real case because she wants her money and they won't pay it. even if they have an agreement about what the law is. and 5-format and what i would call a vintage classic confusing anthony kang opinion, the court says that doma is unconstitutional and it's got a lot of great rhetoric but very,

very little constitutional law. that's what i meant to say they are modestly the victory to a legal victory in the prop eight case, supreme court essentially saying take us away. we really don't want to decide this yet the taking at all would back down to the district court. and in the winter case, the court 5-4, as close as it could become and somewhat monday in advancing this attitude is unconstitutional. but politically, very different. >> so this is for the plaintiff. what made you decide to become the lead place in the prop eight cases? what was the greatest impact of the actual trial on you, on your family? and but with most challenging moments for you and your family? and what were the most rewarding and so the most challenging and the most rewarding, center, we will start with you. >> that's a lot to answer. well, what they want to be placed in the case is that we

believed in the approach. we had been through the prop eight campaign, and some of the same disappointment that everyone else did. and it was quite devastating to us but we been married in 2004 in san francisco when it was allowed and that marriage was taken away from us. even though we have a lovely wedding and her friends and family felt that it was, in fact, taken away from us legally. and that really dealt a blow to us in our family and our relationship to it was a difficult to celebrate something so wonderful in our lives and then experience disappointment truly humiliation of losing that. we did not get married in 2008 in the brief window because we were so concerned about the possibility of suffering the same humiliation and we decided to wait until it was really legal, permanent legal and we could have that and not worry about having it taken away. when we had the opportunity to get involved in the case, we

talked about it, not about we both really agreed in a strategy but we knew it was possible to impact our family. so we asked the kids if they felt like they would support it. and told them that there could be a certain amount of media involved if we didn't know at the time how large it might become. and, of course, he became quite large. [laughter] the kids all supported us really without hesitation which is really heartening for us, and we made the decision because we felt like it was the right fight, the right place, the right lawyers, the right strategy and, in fact, it was. and so we were of course quite thrilled with the victory. that's how we got involved in the case. >> kristin? >> well, we didn't choose to be lead plaintiffs in the case. that may come as a surprise to lawyers, or maybe you already knew that. plaintiffs don't choose to become lead plaintiff. they can do with the problem and the problem was we've been in a

relationship for 10 years, we have four children and we want to be married and we were doing everything couples do to establish security and permanence and allies, ma and yet we couldn't be married. we tried, even through the city hall wedding in 2004, and that was taken away. so we sort of went dormant in the sense that i think we took our lives back private and we just started going back to work and parenting as we always had. when we found out that there might be a legal challenge and the reason we found that was that i was an acquaintance of chad griffin he was at the time was working in los angeles, was actively looking for people for this case, not just place, lawyers and others who could support this effort. and by being an acquaintance of his we became involved in the case. that's how we got involved. somebody really challenging part of the trial were, no one, that there was a trial. [laughter] what you might not realize or maybe remember now that most of

the marriage cases, if not all, and the non-but i can't take this, with one of% said i'll talk to, marriage cases and counseling have been handled through an initiative process and plaintiffs were not visible, or the survey when the spokespeople for group of people. they might have been inflicted to the effort and made some advances, but in this case we thought we would be doing the. that's what we thought we signed up for. [laughter] >> and they really didn't turn out that way. in fact, i can remember when we went to court to hear about the calendaring and scheduling that the lawyers need to know about in order to file the brief and to all the work that they do, and boy, do they do a lot of work. you are all amazing. for anyone here who did any help with amicus brief weekend to watch a went to support the lawyers on our team in some way, thank you. because really it took a team of dozens and dozens of attorneys over many years, and not just

these attorneys but attorneys on other cases. the challenge part was that it was a trial, and then having to sit through almost three weeks of testimony and argue this from the other side that were very familiar because they sound like the political rhetoric that the use in the campaign but and if you all recall, sort of strategy that relied upon and at the local campaign was sort of caste living and gay couples as different and disagree and not worthy of something as special as marriage and certain not good enough to be a deterrent to for sandy and i with four children we love dearly and the friends who we loved it and all the other children in california who want help, that was just to much to tolerate and it was hard windows conduct overcame the we watched the ad seeking to listen to them, talk to the judge or how we were not worthy and her children with her and her that as well. and i think is a really difficult experience and to help

someday the video is sensitive and all of you can see what we saw and heard in that courtroom because even though they wanted to convince the judge that they were right, they had no evidence and they couldn't back up any other claims, and i think that's why we want is that the 17 witnesses we have compared to the queue they had were using data and evidence. to explain how meaningful and helpful marriage is, the people are married are healthier and wealthier, that they are happier in many cases and that their lives are enriched by marriage, and certainly knowing you the option to be married what you choose or not to seem helpful. so that was a great, but how is the good news come and the hard part was the news that came out from their site. >> enrique, what made you decide in what made you choose these particular plaintiffs in this one out they didn't get to choose to be the plaintiff.

and in other words, with the been the perfect test case? attorneys the fight for civil rights tended use cases where the facts on key with rights cases. >> our plaintiffs are heroes in our nation's fight for equality. but for the courage and tenacity and their true sacrifice, california would still be forcing property can be would be denied their fundamental right to marry. you know, we didn't have an official search party for plaintiffs as chris alluded to. chris insane and paul and jeff were acquaintaacquainta nces of chad griffin who's the former chair of the american foundation for equal rights, which started -- he asked them and they agreed. what we were looking for couples who were in loving, committed relationships and who are willing to make this sacrifice,

willing to take steps towards federal litigation where other people were not ready to do it. we were so lucky to find chris and sandy and paul and jeff. i think their stories rang so true and were so moving. you just look at them and you feel like they should be together. one of the happiest point of my life, for people to go see them get married once the ninth circuit lifted its stay and we're in l.a. and we ran down to that saw that happen. it was a beautiful day. and congratulations. >> thank you. >> chris insane, where were you when the decisions speed as we were in the supreme court. we were, and, in fact, so happy to be in the supreme court paper also there on the day of the argument. and again i'll say lay people and not attorneys have we really

learned a lot about the legal system and count respected even more than we already did. for its protocols, processes and the decorum and the from out of it i think brings a lot of respect for couples like us who often are not treated that way. and so to come into a place, our nation's highest court, and to be treated in the same whatever else is treated in that room i think was a very personally meaningful thing for me. and i was really happy we are in the courtroom both days, argument day and decision day. because not only were we in a room with people who cared deeply about this as we do, i think the whole countries help by these decisions, even though i think there is a public opinion and the court opinion and they are slightly different. i think it brought us together as a country, as a state, unlike any decision recently. so what i loved about being

there was for ever remembering sandy why my side, jeff and paul, chad, and all the people of been with us for four and a half years just waiting for the day that it would be over. because even though it ended differently that we might have hoped, it was over. [laughter] and that was really a good thi thing. and every time without something was over to our lawyer said no, it's not over. [laughter] and i just thought well, okay, so we will go back again on an unknown date. but it is over and we walked out and people were so joyous and celebratory outside the court the entire day i felt like we're sort of writing on a cloud of happiness. >> chris, is there any way that these decisions can be undone in the future? >> well, for joy that's an easy answer but i think the chances essentially is zero that these cases could be undone. one of the nice things about

being in the supreme court is when you're interpreting the federal constitution, your decision is about as final as file gets. so the only way the supreme court decision could be overturned would be either a federal constitution amendment, which is very, very difficult to do, or a future change in the composition of the court that causes them to reconsider their decision. neither of those is very likely any time in the foreseeable future. >> so chris and matt, can you griffin described what you believe the national impact of the supreme court decision is? and from a legal perspective, can you respond to that from a civil rights perspective question you respond to that and then from a societal perspective? >> well, from a legal perspective, as i said, in some ways the prop eight case from

you, judge walker's decision is in place but i think judge walker's decision is best decision in a marriage case there's been so far but as you know, the decision of one trendy district judge is not binding even on any of the united states district judge. so from a strictly legal sense it's a modest. i think judge walker's decision because it is so good will be valuable from a legal standpoint. the doma case gives us a little more. for the first time the court really suggests that even when, the court has two basic ways of looking at the quality. most of the time it says we leave question of whether two groups of people are equal or unequal to legislatures and congress. that surprises most people but that's basically what the rulers. we will presume that different treatment is constitutional because people are really in a totally didn't situation. and quiet rarely they will say,

we are historic was suspicious of certain kinds of classification of race, gender, nationality and we always look at those very carefully. the doma case dozens they will treat sexual orientation classification carefully. it still leaves us with anybody can tell back and presumptively constitutional. but it does say that when there's evidence that you single people for different treatment based on hostility or a sense that they're really different, does that change the calculus and make the court take a closer look at a? and i think that will make it helpful. it's taking down anti-marriage laws and other places. but i think it means you've got to be very, very smart about how we do it. we've got to look for the best targets at the. there's a lot of targets, about 45 targets out there, and we've got to look for the best because there are great differences between them.

from a civil rights perspective, because the prop eight case doesn't get to the constitutional issues and the doma case does so languidly of this, i don't think there much of a boost. the courts decide that its judgment about voting rights was more important than congress is voting rights and more important than the unanimous united states kind of disappears earlier. i don't think there's a great boost to civil rights, i really don't. they are fabulous. i mean, really, i think the political sense of this is it's not going to be stuck. we are on it. they key is to make sure you make maximum use of political traction can smart use of the legal traction which is probably at this point a somewhat modest -- get things lined up.

justice scalia's dissent is always important to read the justice scalia's dissent in the windsor case says there are five vote to destroy damage. get the case as quickly as possible. you may think he is our friend and telling us what to do. you may think he was just exasperated and throwing up his hands and thinking. or you may think, as i do, that he thinks this is the last chance to get a supreme court majority is that states don't have to require -- if he wants to get something through an unwell crafted it as quick as possible so you can use it as if he can get anthony kennedy, which come with this, the way everybody thinks this is breaking. kennedy says not a word in any of these opinions about how he feels about that question. he is deeply tormented. what i take away from us, make as much out of this politically

as we can. be a smart about it from a legal standpoint as we can. >> where do you think the next best target is? >> i think there's a bunch out there. i would go after the most extreme amendments. and doma that are out there, virginia thing for example, even invalidates the will between same sex couples. i think that's really extreme. there's a case in north carolina that frames the marriage question up in terms of recognizing people as parents but i think it's a great way to do it. especially with justice kennedy. generally speaking, i think statutory defense of marriage acts are better than constitutional is because they give you better watch said record work with and you don't have to ascribe a motive for the entire pipe us of the state. you've seen the state legislatures. it easier to do it there. i don't think there's a single

answer to what the best witness but i think there are a range of considerations out there. >> chris, legal, civil rights, society. society. >> i take a slightly different optimistic view of the decisions legal effects than matt does. we had this amazing language -- by the way, i should mention went to was in aclu case so we have -- met and the aclu to thank for that wonderful decision. and it really is the most sweeping affirmation of lgbt called reversing from our supreme court, you know, the first time we've ever seen language like justice kennedy's language talking about doma as a long that denigrates same-sex couples and their children and since this terrible message of any court to the children and marks them as second class, the relationship as second class marriages. and i think all of that language

and all of the reasoning behind it is going to be tremendously helpful as we go forward, because a law from a state that says we're not going to recognize your marriage, if you move here from california it is ever bit as denigrated and every bit as much of a marker as second class status as doma was. and i think we will find that windsor is a big driver of the quality, legally and socially. >> enrique? prop eight supporters have been saying the statements were not victory for the lgbt community. it cannot create a federal constitutional right to same-sex marriage as it did for abortion in 1973. and it did not declare same-sex marriage as a civil rights along the lines as it did for ethnicity and nationality. how would you respond to those statements? ..

just like everybody else in that allowing the people to get married isn't going to affect anybody is heterosexual marriage. so when we have a state like california that is so large allowing more same-sex couples to get married and have families, i think that really pushes forward the discourse and marriage a quality that much sooner. >> what is your response to that? >> technically right and socially wrong. they are technically right that

it doesn't us -- the nation why the right but the technically right it is in that sense the kind of legal watershed that gives way. but that is just people trying to deny what is going on in the country. look, if you go back to 2008 when proposition 8 past, we have two states that allow same-sex couples to get married at the time proposition eight was passed. within a few weeks if we picked up a few more, we picked up iows embrey que said the numbers that get us to 13 with california and most of the states through the state legislature is acting not through the courts doing it today anybody that misses the significance of this becoming i think in america since something that needs to happen, something that historical is going to happen that needs to happen soon. it is just to underrate the

scope of the victory by the technicalities. >> okay. kristin. many will tell you that achieving marriage equality in california is the beginning of a much bigger challenge. next up are issues like employment discrimination, for example the 29 states, lgb are not protected from workplace discrimination and in 33 states, transgendered will not be protected. protection against bullying and adequate punishment for bullying is an issue. there's been an uptick in the lgb community and no marriage equality in other states just to name a few. what did you see as the most important issue on the path to equality for the lgbt community? >> first of all, enjoy the fact that for now -- no, no. for the result one of the problems which is sort of this

enormous problem of our government telling us that we are not equal. and the harm that that was causing sandy and i and literally thousands of other california residents. and most importantly, children. and i think when you look at any of the other laws that discriminate in employment sites or schools where children are permitted or encouraged to be mean to other children. but that really all reflects is a very big problem of homophobia still in america. and those policies are just formal sort of mandates in that homophobia. what was important about the trial, and i do believe the decision is incredibly powerful and so is the record, is it shows how insidious and painful homophobia is, and even in the term we do some of the things to

ourselves as gay people, lesbian and gay, transgendered people that people aren't even doing to us. and if we are doing this to ourselves, telling ourselves we don't deserve certain jobs or to live certain places or be happy and the parents, we are transmitting that to another generation and another generation. of course there are policies and of course there are laws that formalize those beliefs. the work may be to go out and undo a bunch of laws or pass new and better laws that underwrite those other law. my passion is more about humanity and human development and the capacity to be more loving and accepting verses to be so exclusive. and that is a state of mind you can make a great policies and do great things as a lawmaker and an elected official and great things as a teacher and an

employer. but someone has to get through to you that you are harming people in your workplace and school and home or neighborhood. and i see that as the work sandy and i still have to do. it's one thing we got to be married and it feels great. and i can tell you being equal feels better. it does feel better. our children can tell us it already feels better. we are so sad they are already 18 and older and didn't have their parents married when they were growing up. but they found something historic and momentous happen. and that will change their lives and i think they will expect more than other people. and i hope all of you and young people across the country and in the state will see this as an inspirational moment that helps them us buyer to lead in their own life. and that is what changes all of that other nonsense actually that's going on out there where

people get away with putting these terrible laws on the books. >> it's just be heading that way. >> so, sandy what do you think is the next most important issue on the path to lgbt ecology? >> after this inspirational talk about humanity, i think we have to have a country where you don't have to live in a certain state to get your rights. i think the fight is not over. i'm from iowa and i cannot tell you how ironic i found it to be. [laughter] my conservative mother saying can you believe i ely has a marriage and california does not and i actually kind of couldn't believe it. but i felt like marriage equality, workplace discrimination laws.

antibullying, transgender writes, they all matter but we cannot have a country for just cause you were born in a certain state that means you just have to live a second class existence your entire life. we have to have more balance in this country. and we have to find a way to support our southern brothers and sisters and families so that we might have more balance in our country. i feel like we have such a divide between urban and rural and sometimes coastal and mom coastal, and right now we certainly have a huge divide over how we are received in terms of the government. and in fact the federal government recognizes us which is a fantastic and wonderful achievement and makes it all the more painful waiting for individuals to be in these other states to get past their own state law to try to reach the same benefits and the same rights that people who may be

with 10 feet away. you shouldn't have to move. you shouldn't have to leave. you should be able to grow up and raise your family in the place that you ought to be around your relative and your home and have the same rights as anybody else in our country. so i think we have got to bridge that divide that we have geographically in the country. i absolutely think we have to address it as a human issue as well. >> what is your take on that what is the next best issue in your life? >> we can take a page out of history and kind of learn from the civil rights movement and really see that attaining the formal legal equality is not the end of the struggle. it's really just the beginning. and we have seen obviously in cases this year how long that struggle has been in the civil rights movement and how even there are defeats.

w important it is that we not leave out the other half of america in terms of getting formal marriage equality and recognition that there are a whole host of other issues that are longer-term and harder to solve and do not lend themselves to one big impact case and you're done, things like bullying in schools and employment discrimination all these things that require constant work in the legislatures through policy advocacy and on a case by case basis and they don't just get better with one case. that's what we are going to get focused on i think. >> i think chris and sandy have put it really well. you can't really make the change. it's a lesson that every movement for social change in the 20th century. you can't make the change unless you change the rules and get people to accept the change in the rules. for the movements that have sputtered as i think largely

some point or another focused too much on the formal legal equal the and not on that second part and i think it is essential to make any kind of change real. the other thing we should keep in mind is while public attention for the last, certainly the last five and maybe closer to the last ten years has been largely focused on lgbt issues on marriage. it's not like there haven't been other things going on. i can tell you that nclr and the aclu didn't stop doing things on bullying cases and child custody cases, didn't stop working on gender equality and trans equality. almost all of us expanded and took on a bigger program and of those things haven't gone away. and the marriage in california that the federal defensive marriage act isn't going to make it go away. they are all moving forward and the key to this is i think that

persuading people that humanly we are not really different. we have the same kind of relationship, the same kind of emotional attachments good and bad that everybody else does. when you see that range is the same that is the key to fighting off all of those. marriage is a great way to illustrate but it's not the only way. we have to keep pushing the whole thing forward. kristin and sandy other than the fact you were the first to be married in city hall -- congratulations by the we -- how has the outcome of these two cases changed your life in the last month or so? >> i'm 48-years-old, and for 30 years since i turned 18i just assumed i would never be married. know whether i found love or not i would never be married, and for two weeks i've been married

to that i don't believe it until i see sandy and i remember that i really am married. and i can tell you that everything that our heterosexual lawyers and mary the lawyers told us was important about this institution is true. there is a sense of responsibility and commitment that deepened and we talked about it for both a little bit in awe cow it shifted us from this temporary worried that the outcome wouldn't be one that would be on to celebrate and that would be taking a big risk and not be successful so the worry of that was very big. having about lifted and then be replaced with a great sense of permanence and a bright future has been wonderful. absolutely wonderful. i wanted to laugh.

[laughter] >> i had an interesting experience a couple days ago. we were in washington, d.c. and i was renting a car. i was staring at the paper work and things that are you the only driver and i said no i want a second driver. do they have to be here? they said no, as long as you're married. i said i am married. [laughter] i'm not used to it. my first cool little benefit. he said okay then i will just put your husband's naim down and i said no it's my wife. he said i'm sorry. of course, i will just put that down. i will put down spouse. and i thought yack put down spouse and change your forms and don't ever ask anybody that again. [applause] but i'm so used to using the

word partner and having that feeling about that like it feels sort of bad. it does feel second class. it is second class. i'm not a lawyer and i never aspired to be a partner in my life. [laughter] but the word wife is working out pretty well. it really does change. the day we got married and i got my ring, because we are gay people we need lots of rings to commemorate our marriages. [laughter] the day we got married, i honestly felt calmer. i felt like my heart rate and blood pressure went down a little bit. like yes, things are going to be okay. this is the real deal. our families are going to understand it better. and we can stop fighting for it and stop being in court over it. and we just both felt a lot calmer and i felt a legitimate in some bizarre way because in our country and in our society,

marriage means something. like one of the other plaintiffs said come it didn't matter so much we wouldn't be here. it does matter and that's why $84 million to try to keeping us from having it. it matters in a different way. it matters to us. it's benefitting knous and other people. i cannot underscore this enough. we have heard stories about couples who had they just been able to get married, you know, one couple that we heard about from our lawyer, a couple in california, one of them passed away just before you could legally get married and before the doma came down. because of that, her partner of many years will just suffer from the consequences of that. and they are very severe for those families. very severe for the bread of winning this house passed away and the stay at home mom was left. these are significant consequences. and like it was said in court, every day that you do not come

to this long, people suffer and it's true they suffered. it's not just emotional. it can be financial. and there are horrible consequences. and for us it is wonderful to be married. we feel so happy about it and i'm less worried about our future but i also feel like good, there are people out there that got their just reward today and that matters so much just not even funny. we are so happy about that part knowing that the people we don't know have a better day to day. >> so what have your children said have change for them since you have been married? >> well, you know our children are now adults so we see this in a sort of random way that you see your adult children. they are all extremely happy and relieved as we are. and i think they all have friends tell them how impressed and happy they are why this struggle that we have been in and that we made it to the other

side. so, i think for them. recognition and support has been a huge part of this and in some ways they feel admired i think for having been involved in something that has affected lots of other families. and also i believe they are so happy for sandy and i that we are done. this is part of our lives the was full of uncertainty, and now it's still possible have a future. and they want that for us. while they are starting their new life we are starting our new life. >> of the california case on procedural grounds, the supreme court avoided unnecessary reckoning about a fundamental violation of the equal protection created by the state law that prohibits the same-sex couples from marrying during its perpetuated a patchwork in which the newlywed couples may not be considered married when they cross the borders.

therefore, if a couple was married in a state that recognize same-sex marriage like california, what are the implications of that couple moving to a state that does not recognize same-sex marriage such as tax filing, getting divorces, etc.. >> i can start now that we have doma gone, one thing that is very clear is couple's daughter married in a state like california that permit same-sex couples to marry and live in a state that permits same-sex couples to marry, those couples will be entitled to every federal right and benefit that any married couple has. that's very clear and it's a matter of time before the federal government implement all those things as they have moved very quickly to do. that is absolutely clear. the only other complication arises when a couple married in california or in another state

moves to a state like florida or texas that doesn't respect their marriage. and until we succeed in getting rid of the remaining marriage bans in these states, it's clear that those state governments will not recognize these couples that are married and they will get some but probably not all of the federal benefits that they would get if they were living in a state that respected their marriage. the administration has been coming out with guidance on various benefits since the decision came down. so we do have some answers at this point. it seems pretty clear that for immigration purposes, the federal government is going to respect the marriages of couples that were married in any jurisdiction that allows that no matter where the couple lives now. it's clear now that federal employees will be able to get spousal health insurance and other benefits if they are legally married in any state

regardless of where they currently live. the same for military spouses. so we do have some clarity on some of these issues. the two big ones that are sort of standing and that we are still waiting for guidance from the administration on our social security and taxes and i expect we will get guidance in the near future. there are additional issues with those two because of some statutory language that excess and the administration is kind of working through what benefits can be provided in those areas. so that's where we are on a practical matter in terms of the federal benefits. >> on the one hand about taxes if you are living in a state that recognizes the same-sex couples there is no question that he would be treated for tax purposes like any married couple. the purpose is whether as an immigration our military they can't ask that further out and it's much tougher than it is in some other areas to do it because as chris said the statutory framework.

ultimately, people think that the federal constitution requires the state to recognize marriage even though it was entered into another state. the truth is states do that almost universally but not because anybody has ever interpreted the federal constitution to say they have to. they just do it. they can extend the recognition to the driver's licenses, corporation papers or marriages. the question that comes up is what happens when the state does it? there is widespread in this country for much of the latter 19th and first two-thirds of the 20th century that wouldn't recognize interracial marriages. but none of those cases just about the cross border recognition never got very far in the federal court system. so we don't know whether one state can refuse to recognize

marriage from another state. i will say this. the way that i get the rules it seems pretty clear to me that if you are married in the state recognizes your marriage, new york or california and you are traveling to another state and that state institution doesn't recognize your marriage i think they are going to have to. we may bring a challenge but they will have to. if your travel and you were in hospital but refuses to recognize marriage i think there would be a good case to bring. it transfers harder but the more the transfer looks like something in voluntary, the better unlike the case i think it comes from somebody across the state line to get married because their state won't marry them and then it hops back and that isn't a very good case. >> i will just add this situation we have states not recognizing the marriages means even now for california couples that are married it is very

important to have things like health care proxy's and power of attorneys for finances and to do at options for your children and have those papers with you because you never know what might happen when you are traveling in another state and you really want to protect yourself as best you can >> so if someone wanted to learn about this mismatch of benefits now that we know people have and some are still trying to figure out, where can they go to figure that out for themselves? >> we have lots of information on both of our website. actually, for the federal benefits, all of the major lgbt organizations have put together fact sheets that are available on all our web sites that go through the federal benefits, and particularly dealing with this question about what happens if he moved to the nonrecognition state. and on our web site, that is that nclrights.org/afterdoma and

other web sites. >> we are going to move to the part of the program i call round robin. you have been through this with me before. i'm going to throw out a statement and you are going to take about 15 seconds to give me a provocative fault or opinion on the statement. so, since the supreme court decision, how impact spousal green card, anybody? >> the federal government will recognize your marriage but still talk to the experienced immigration lawyer because there are many other things that can affect you. >> he's right. >> it doesn't have to be a legal opinion. the ideas on the spousal green card applicants after these positions. >> i think a lot of people are going to be relieved. >> social security, 401k and

veteran's benefits. >> we are all getting older. [laughter] we have to pay attention. it's really important to have equal access to the kind of economic safety net that the rest of our society has. >> this stuff is complicated if you are in a heterosexual relationship. now it is at least the same level of complexity that everybody else does. >> health care rights and partner decisions for the lgbt community. >> i don't think that you can just assume because you are married that you really know what to do in the case of your partner having a health crisis are having to make decisions for them that they can't make for themselves. it doesn't automatically make you omniscient. we have to have a conversation again because even though we didn't run 12 years ago, we are probably due for a check at.

so i would say this is a nice reminder that it's time to get those conversations going again because the state planning and health planning are important and they are not address in your marriage. >> we still see some cases where people that have the proper papers don't have the relationships respected, and that can still happen. >> having an or adopting and raising children is really, really hard. [laughter] >> hopefully this will make it easier for people to form families. but almost as importantly, those children that they have to grow up more secure feeling like their family is more like families around them and that is remarkably important for the social and psychological development of children. >> and for young children growing up that haven't fallen in love yet and haven't decided

who they want to marry or if they want to marry or if they want to have children. the idea that all of that potential is there is such a beautiful thing and to feel with -- live with the feeling i don't get to believe what is above it is over for a number of people. and in this state we want it to be over for everybody. having kids is an incredible wonderful thing and to feel protected at the same time is even better. >> we've struggled across the country for years to get the second parents recognized as legal parents. and this doesn't completely make the problem go away. but it makes an awful lot of it go away in the states that recognize marriage for same-sex couples. >> it was about their four boys and the recognition the state would give them and how they would feel in the major theme that came up with justice kennedy was very concerned about the 40,000 children that live in the families led by same-sex couples.

i think it's a really big deal. >> i think that covers it. >> after these decisions, what do you think about whether the transgender rights are still a step behind lesbian, gay and transsexual rights? >> i think they are behind but in the issues for transgendered people it is different. so the things that are important are access, nondiscriminatory access to quality health care, access to identity documents and things that do not face same-sex couples necessarily. >> after these two decisions, what do you think about political involvement in our personal life? >> one of the great things about this case has been the allies that we have been able to create, the bridges with other organizations. being gay and lesbian is one

aspect of the community that we have many different communities. we are latino and african-american, and we are able to build these collisions. and so i think that moving forward i think that our community hopeful we will go on coalitions built and we will be able to help others in their fight so that we can get that support back for our own a continued move towards equality. >> i think one thing that made our case so successful is that it was not really -- it didn't move forward on the political lines. but by having these bipartisan lawyers, we approached it as a common cause. it's not a political fight. it's a civil rights fight. and i think that that helps us be successful. and i think that could be we could leverage that type of approach to other causes as well because they don't need to be political with their civil rights. >> at the risk of sounding like

a broken record, we have got 13 states. that means we have 37 more on marriage. we have all the other issues that we outlined. and the one thing that we know would be a mistake would be to start thinking just about changing the legal rules and getting the formal legal equality. if we do that we will falter and then we will have a great wind behind it now and will not succeed. so the bottom line is get to work, and that does mean political in your personal life. >> did you have a comment? that segues nicely into my statement. what are your thoughts on how the impact of this decision, the impact of the decision will have on the discussions around the race and class and sexism in this country? >> fools rush in i guess.